gha board meeting agenda · the practice of acupuncture by physiotherapist should be governed by...

GHA Board report – October to December 2015

GHA BOARD MEETING AGENDA

Venue: Charles Hunt Room, John Mackintosh Hall at 2.30pm

Wednesday 20th April 2016

1. Apologies for absence

2. Minutes of the meeting held on Wednesday 10th February 2016

3. Matters arising

4. Statement by Minister

5. Matters for discussion

5.1 Chairman’s Ruling on amended acupuncture policy 5.2 Mobile Devices policy 5.3 Long service and good conduct medal policy

6. Matters for report

6.1 Report: Chief Executive 6.2 Report: Director of Public Health 6.3 Report: Director of Finance and Procurement 6.4 Report: Director Estates and Clinical Engineering 6.5 Report: Director of Nursing 6.6 Report: Director of Human Resources 6.7 Report: UGM – Hospital Services 6.8 Report: UGM – Primary Care Services 6.9 Report: UGM – Mental Services 6.10 Report: Director of Information Management and Technology 6.11 Report: School of Health Studies

7. Date and time of next meeting 8. In Camera session


2 Minutes of the meeting held on Wednesday 10 February 2016

GIBRALTAR HEALTH AUTHORITY Minutes of Meeting held on Wednesday 10 February 2016 at 2.30 pm in the Charles Hunt Room, John Mackintosh Hall. Present: The Hon. J Cortes (MH) - Chairman

Mr F Pitto (FP) - Chief Executive Mr E Gomez (EG) - Chief Secretary Mr C Lavarello (CL) - Non-Executive Member Dr K Rawal (KR) - Medical Member

Apologies: Dr D Cassaglia (DC) - Medical Member Mr E Lima (EL) - Non-Executive Member Mrs P Galliano (PG) - Non-Executive Member Mr M Netto (MN) - GTC Member Mr A Mena (AM) - Financial Secretary

In Attendance: Mr G Teuma (GT) - Director of Finance & Procurement

Mr D Figueredo (DF) - General Manager St. Bernard’s Hospital

Mr A Wink (AW) - General Manager Primary Care Centre Mr H Watson (HW) - Director IM&T

Mr P Linares (PL) - Director of Human Resources Mr C Chipolina (CC) - General Manager Mental Health Mr D Alman (DA) - Director of Estates and Clinical

Engineering Secretary: Ms E Fa (EF) 1. Apologies for absence: Dr D Cassaglia (DC) - Medical Member Mr E Lima (EL) - Non-Executive Member Mrs P Galliano (PG) - Non-Executive Member Mr M Netto (MN) - GTC Member Mr A Mena (AM) - Financial Secretary Welcome from Chairman: The GHA Chairman opened meeting. 2. Minutes: Minutes of meeting held Wednesday 30 September 2015 approved as a true record. 3. Matters arising: No matters arising.


4. Statement by the Minister:

Pleased to be back as Chairman of the GHA Board. Thanks the Board members for their

attendance. Apologises for the delay in GHA Board meetings due to elections and Christmas

period. Next meeting will be for the period October to December 2015 in April to catch up.

5. Matters for Discussion:

5.1 Acupuncture Policy (Chairman’s Ruling) MH – This is a new GHA practice and there was no established and approved policy. Physiotherapists wrote a policy and submitted to the Executive Team. This was approved and MH ruled in advance of the Board meeting due to the clinical need. Asks Board to formally approve the policy. AW – Acupuncture is recognised as a legitimate modality for the treatment of lower back pain within NICE guidelines. This is an extension of the policy for the treatment of lower back pain. MH – Acupuncture policy approved by the Board. 5.2 Wi-Fi Policy HW – The GHA for the last 18 months have engaged in a major project in the hospital with the installation of the Wi-Fi infrastructure. This was accepted two years ago and spread over a period. This is now at the stage where it can be switched on. There will be a patient Wi-Fi network and a GHA clinical use Wi-Fi network. CL – Refers to paragraph 4 and 5 of the Wi-Fi policy. Paragraph 4 on patient access self-serving points. What effect does this have putting it into a policy document if what we are trying to do is put the responsibility onto the users to ensure they are using the service appropriately. Refers to appendix A and asks if this will be appearing in the patient’s devices when they log in. Is there any advantage in taking some of the points that appear in paragraph 4 and 5 which don’t appear in the appendix and putting them in there. Specifically the ones relating to the use of the internet services. MH – HW to look into this and send to CL for comments. Policy approved on the proviso of the amendments to onscreen users. 6. Matters for Report: Chief Executive’s Report: (As per published in Board Report) All Directors’ Reports were taken as accepted.

Question Time: None this meeting Meeting ended with agreement to reconvene on Wednesday 20 April 2016. With no further business the meeting closed.


5.1 Chairman’s Ruling on amended Acupuncture Policy

POLICY NAME:

Acupuncture as an adjunct to the

management of musculoskeletal

conditions.

Issued by: Angelique Fortuna

Date approved by Clinical Governance Group:

Date approved by Senior Management Group: 8/3/2016

Date approved by GHA Board:

Policy Authority: GHA Board

Effective Date:

Review Date:

POLICY STATEMENT:

This acupuncture policy sets out to ensure that acupuncture is performed by appropriately

trained professionals who are employed by the GHA (Gibraltar Health Authority) in a safe

and effective manner, and that patients have the appropriate information in an appropriate

form to enable them to make an informed decision before opting for acupuncture treatment.

The practice of acupuncture by physiotherapist should be governed by Rule 1 of

Professional Conduct of Chartered Society of Physiotherapy (CSP):

‘Chartered Physiotherapists shall only practice to the extent they have established and

maintained their ability to work safely and competently and shall ensure that they have

appropriate professional liability cover for that practice’

The giving of appropriate information to aid an informed decision on opting for acupuncture

is central to this policy.

APPLICABILITY:

Following a detailed clinical assessment, acupuncture may be offered as part of a package

of care when 1) the best available treatment has failed to be effective, or 2) where

acupuncture is equally as effective as conventional physiotherapy treatments. Acupuncture

is not available as a stand-alone treatment except in cases where evidence indicates

acupuncture is more effective than any other physiotherapy modality e.g. when a patient has

radicular pain and is awaiting a spinal clinic appointment.


3.

DEFINITIONS:

Acupuncture is a therapeutic modality involving the insertion of fine needles using current

knowledge of anatomy, physiology and pathology, and the principles of evidence based

medicine.

RELATED POLICIES:

GHA spinal policy for non –specific low back pain. February 2014

The disposal of sharps

GHA needle stick injury

FURTHER INFORMATION:

Guidance on commissioning for AACP members

A summary of evidence for the use of acupuncture in physiotherapy for the benefit of the

patient

The following persons are responsible for clarification and compliance with this policy:

Ms Angelique Fortuna - Senior Physiotherapist MSK services;

1. SUMMARY OF THE POLICY

The acupuncture policy has been developed to ensure safe and effective practice of acupuncture by trained clinicians and physiotherapists employed by the GHA and to ensure that patients are given enough information to make an informed decision about opting for acupuncture treatment. It is evidence based and the AACP published the evidence in February 2012 which provides a summary of evidence which should be used to support acupuncture continued use in NHS physiotherapy practice which is reflected in the GHA. This document is attached.

Acupuncture treatment will be offered by a Physiotherapist with current Health & Care Professions Council (HCPC) registration who has undertaken an Acupuncture Association of Chartered Physiotherapists (AACP) recognised training course in acupuncture.


2. OBJECTIVES OF THE POLICY The objective of the Gibraltar Health Authority in Establishing this Policy is as follows: 2.1: To outline the scope of acupuncture in the GHA 2.2: To outline the provision of acupuncture in the GHA 2.3: To ensure the safety and regulation of acupuncture in the GHA

3. SCOPE To be used by appropriately trained clinicians and physiotherapists working within Gibraltar Health Authority.

4. GENERAL POLICY Location of Practice

Acupuncture may be practiced in any of the environments below as long as an appropriate clinical area is provided:

St Bernard’s Hospital

Primary Care Centre

Patients place of residence 4.1. Referrals

Patients are referred to Physiotherapy by the usual way 4.2 Regions which should NOT be needled

Any points with area of swelling

Cancer patients that have had lymph nodes removed from any limb

Nipple and breast tissue

Umbilicus

Infants fontanels

External genitalia

4.3. Contraindications and Precautions 4.4. Contraindications The following are considered contraindications to acupuncture needling

Unstable heart conditions e.g. CCF, arrhythmias

Acute haemorrhagic strokes

Patients that are undergoing chemo therapy

Inability to cooperate/unable to provide consent

Poorly controlled diabetes

Infected/fragile skin

Pacemaker (electro-acupuncture);

Phobia of needles;

Local infected areas.

Pregnancy (first trimester)

4.5. Precautions

Diabetes- impaired skin condition, unstable blood sugar

Pregnancy – if appropriately trained


Patients without a clear diagnosis (may mask serious pathology)

Haemophilia, Anticoagulant therapy

Known metal allergy

Hepatitis B or other blood borne virus such as HIV

Hyper/hypotension

Immunosuppressive diseases e.g. AIDS (extra attention to hygiene) 4.6. Consent

The following process is required:

Patients are given information regarding the treatment benefits, side effects, complications and procedure to allow for informed consent (Appendix 1). If they are unable to read the information in Appendix 1 it will be given verbally, using interpreters where necessary.

The patient’s consent to treatment must be unequivocally obtained (from the parent in the case of a minor).

Consent is documented in the Physiotherapy records along with the clinical risk assessment ( Appendix 2)

If electronic records are used for that patient’s episode of care the consent form should be scanned into this.

4.7 Complications of needling The following complications may occur:

Needle stick injury – follow GHA policy.

Fainting or fatigue – remove needles immediately and manage as a first aid emergency. Complete an incident report form.

Bleeding or bruising – certain points are more prone to bleeding. Apply immediate pressure to the area and advise the patient of possible bruising.

Temporary flare of pain – remove the needles immediately.

Infection – always use a sterile needling technique. If skin becomes red, itchy and raised, remove the needles and review at a later date

Stuck needle – usually due to muscle spasm around the needle. Gently massage around the needle to relax the muscle and gently reattempt removal. If unsuccessful remove all other needles and insert another needle near to the site, wait a few seconds then re-attempt removal.

Broken needle – Mark the point of entry and go straight to A&E. Complete an incident report form.

Bent needle – if you suspect a needle may have bent due to a patient suddenly moving, allow the patient time to relax and then gently manoeuvre the needle out. If unsuccessful send to A&E.

Pneumothorax – seek immediate medical assistance and complete an incident report form.

Drowsiness – if it persists longer than 10 minutes, keep the patients in the department for longer and if necessary contact a friend or relative to assist the

patient home.

Allergic reaction. 4.8. Needling Procedure

A risk assessment completed (see appendix 2)

Only presterilised, single use, disposable needles maybe used.

Wash hands before inserting and withdrawing needles;

Needles are counted in and out


Patients skin is checked before and after treatment paying particular attention to the needle sites;

Patients are positioned to allow for maximum comfort and safety;

Patients are safely monitored during the treatment session;

Patients must be able to summon someone if required

Needles are disposed into sharps box immediately after withdrawing them;

The GHA Sharps Policy is adhered to.

Anything other than needles, e.g., the needle wrapping, cotton wool must be disposed of in the appropriate bins.

Needles/ the sharps box must never be left alone in the cubicle with a patient unattended (case of a child putting his hand inside a sharps box)

The AACP does not recommend that disposable gloves are used regularly only in some clinical situations (Appendix 3 recommendation of disposable gloves)

4.9 Safety For safety reasons, the following process should be followed: 1 The Environment:

Be clean and private

Have a facility of disposing sharps close by

Ensure the patient is adequately supported. 2 The Practitioner

Wash their hands before and after each treatment.

Have the knowledge to treat the patient

Discuss with the patient the benefits of the treatment and provide alternative options

Have screened the patient for contraindications and precautions (Appendix 2)

Know the anatomical structures relevant to the selected points

3 The Patient

Be adequately informed of the benefits and the risks of receiving acupuncture with evidence where appropriate.

Alternative treatments for their condition.

The procedure of insertion and stimulation

A warning of any transient symptoms they may experience during or after treatment such as light headedness. Reassure the patient that these are common reactions

Patients are allowed sufficient time to rest and recover safely after treatment

The current (AACP) safety standards should be adhered to. 4.10 Training The following training must be carried out:

Any staff member practicing acupuncture within the GHA must be AACP trained and fall within the guidance of the AACP and the HCPC regulatory requirements.

Evidence of adequate training must be seen by the line manager and a copy of the certificate is advised.

10 hours continuous professional development (CPD) every 2 years is recommended by the (AACP) and this level of update should be followed by physiotherapists to maintain their competency.

That the GHA provides protected time to maintain their competency.

Mandatory CPR and anaphylaxis training is current and maintained.

See attached Appendix 5 4.11 Documentation

The following documentation is required:


Risk assessment form completed

Complete the treatment table – inclusive of all points needled the stimulation technique and the needling time. (Appendix 4)

Any adverse effects

Information contained in the information sheet given to patient (Appendix 1);

Consent is documented;

Precautions/contraindications are checked and recorded in the notes;

This policy will be reviewed every 2 years or sooner if new evidence becomes available, and any amendments circulated to all Physiotherapists on the register.

4.12 Monitoring/Audit/Review

On-going CPD must be kept up to date in line with CSP and AACP guidance on acupuncture training and the HCPC regulatory requirements ( Appendix 5) Each department (outpatient/community and wards) to be responsible for collecting data for future audit This Policy will be reviewed in one year. 4.13 References

i. Hoffman (2001). Skin disinfection and acupuncture. Acupuncture in Medicine 2001;19(2) pp112-116.

ii. White et al (2001). Informed consent for acupuncture – an information leaflet developed by consensus. Acupuncture in Medicine 2001;19(2): pp123-129.

iii. Acupuncture Association of Chartered Physiotherapists (AACP) Guidelines for Safe Practice (2012) www.aacp.org.uk

iv. Acupuncture in Physiotherapy : The evidence (AACP) v. Core standards of Physiotherapy Practice (2005) Chartered Society of

Physiotherapy. www.csp.org.uk vi. Guidance on commissioning for AACP members vii. A summary of evidence for the use of acupuncture in physiotherapy for the benefit of

the patient.

.

http://www.aacp.org.uk/

http://www.csp.org.uk/


APPENDIX 1

Acupuncture Patient Information

Please read this information carefully, and if there is anything you do not understand ask your Physiotherapist. 1. What is acupuncture?

Acupuncture is a form of therapy where fine needles are inserted into the body at specific points. 2. Why are we using acupuncture?

Acupuncture is mainly used for pain relief; if your physiotherapist is using it for other reasons this will be explained to you. 3. How does acupuncture work? There are two main models that explain how acupuncture works – the Western Medical Model, and the Traditional Chinese Model. In essence acupuncture works by stimulating pain relief and muscle relaxation responses in the nervous system depending on where the needle is inserted. The insertion of the needle causes the body to release endorphins for pain relief and anti-inflammatory cells and chemicals for healing 4. Is acupuncture safe? Acupuncture is very safe. Serious side effects are rare, less than one per 10,000 treatments. This clinic only uses single use disposable needles. 5. Does acupuncture have side effects?

You need to be aware that the following may occur:

Drowsiness may occur in a small number of patients after treatment. If you are affected you are advised not to drive;

Minor bleeding or bruising occurs after acupuncture in about 3% of treatments;

Pain occurs during treatment in about 1% of treatments;

Existing symptoms may get worse after the treatment (less than 3% of patients). This is usually a good sign and a precursor to a reduction in symptoms, but you must tell your acupuncturist;

Fainting can occur in certain patients, particularly during or after the first treatment.

If you are a blood donor you are not allowed to give blood for the next 6 months unless treated in the GHA.

In addition if there are any specific risks in your case the practitioner will discuss these with you. 6. Is there anything your practitioner needs to know?

Please tell the practitioner if any of the following applies to you:

You have epilepsy, or have ever had a fit, faint or funny turn;

You take medication to thin your blood (anti-coagulants), e.g. warfarin;

You have problems with your heart, or have a pacemaker;

You are allergic to metal;

You have diabetes;

You have any history of cancer or problems with your immune system;

You have a phobia of needles;

You have haemophilia;

You feel fatigued or hungry;

Is there any chance that you could be pregnant?

You may refuse treatment at any time, please inform your practitioner.


CONTRAINDICATIONS YES NO

Allergy to metal in needles

Broken/fragile/infected skin at needle point

Needle phobia

Hemophilia

Uncontrolled movements or uncontrolled epilepsy

Areas of post-surgical lymphodema

Cardiac Pacemaker (for electroacupuncture)

Pregnancy in 1st Trimester, CI poins for 2nd & 3rd

Trimester: LI4, CV6, CV5, CV4, CV3, BL31, BL32, SP6

PRECAUTIONS YES NO

Oedema at needle site

Diabetes

Unstable hemorrhagic stroke

Anti-coagulants

Controlled epilepsy

Immuno deficiency (HIV/AIDS/Hepatitis)

Immuno suppression (Chemotherapy/Steroids)

Skin Condition

Impaired Sensation

EXPLANATION YES NO

Treatment procedure of needle insertion

Stimulation of needle (Manual or E.A.)

Transient symptoms (Fatigue, nausea, faint, bruising,

exacerbation of symptoms)

Warned of possible complications (Pneumothorax, infection)

Warned not to drive, if feeling drowsy after treatment

Patient has eaten prior to treatment

I have checked the above contraindications and precautions. I have given the

acupuncture

leaflet to the above patient and have explained about the use of acupuncture for pain

relief.

Physiotherapist's

Name_________________________________

I have been asked the above contraindications and precautions to

APPENDIX 2

Clinical Risk Assessment and Informed Consent Checklist for Acupuncture

Patient Name: DOB:


acupuncture.

Patient's Name_________________________________________

Patient's

Signature___________________________________ Date_______________

APPENDIX 3

Recommendation of disposables gloves

The AACP recommend that disposable gloves need ONLY be worn if one of the following applies:

If the patient is bleeding profusely If vomit/urine is present If the patient has a known contagious disease (question whether acupuncture is the

most appropriate treatment) If the therapist has lesions on the hand which can’t be covered with a waterproof

dressing If the therapist is handling blood soiled items, body fluids, excretions or secretions.


APPENDIX 4

Treatment Table

Patients Name: Date of birth:

Acupuncture treatment Physiotherapists name

Rx - date

Position of

patient

Selected

points

Needling

technique

‘Dose’

Rx response

/adverse


APPENDIX 5

Peer review and Maintenance of clinical competence

To become members of the AACP Physiotherapists must have successfully completed the minimum standard of training required to conform with international standards of acupuncture training in Physiotherapy, and the HPC quality assurance standards. The minimum training required is in the form of an 80 hour Foundation course, which offers i) A set of learning objectives and outcomes

ii) Offers reliable, validated assessment procedures in order to measure performance against known marking criteria

iii) Conducts an assessment of each delegate against assessment criteria Accredited Membership to AACP set at 80 hours of training Advanced membership of AACP set at 200 hours of training Continued Professional Development (CPD) is defined as “A range of learning activities through which health professionals maintain and develop throughout their career to ensure that they retain their capacity to practice safely, effectively and legally within their evolving scope of practice”. The HPC has defined that the recording of CPD is The sole responsibility of the HPC member

To be recorded in a professional portfolio HPC has introduced an audit system and has decided that A number of portfolios will be selected and audited each year

HPC CPD assessors will undertake random portfolio assessment and audit. CPD may be acquired by a variety of methods including In-service training

Critical appraisal of research

Training courses

CPD courses

Conference attendance

Peer review

Case report submission to the required AACP protocol

Reflective practice

Study days In each the learning objectives and outcomes from the CPD session must be recorded in the

physiotherapist’s portfolio of training & CPD.


EQUALITY IMPACT ASSESSMENT TOOL

To be completed and attached at the end of any procedural document when submitted to the

appropriate group for consideration and approval.

Yes/No Comments

1. Does the policy affect one group less or

more favourably than another on the

basis of:

Race No

Ethnic Origin No

Nationality No

Gender No

Religion or Belief No

Sex No

Marital Status No

Disability No

Sexual Orientation No

Age No

2. Is there any evidence that some groups

are affected differently?

No

3. If you have identified potential

discrimination, are any exceptions valid,

legal and/or justifiable?

N/A

4. Is the impact of the policy/guideline

likely to be negative?

No

5. If so can the impact be avoided? N/A

6. What alternatives are there to achieving

the policy/guideline without the impact?

N/A

7. Can we reduce the impact by taking

different action?

N/A

Name of Policy/Guidance Notes/Guidelines assessed: Name of Assessor: Grade: Signature:


5.2 Mobile Devices Policy

POLICY NAME:

Mobile Devices Policy

Issued by: Director of IM & T

Date approved by Corporate Governance Group:

Date approved by Senior Management Group:

Date approved by GHA Board:

Policy Authority: GHA Board

Effective Date:

Review Date:

POLICY STATEMENT: The GHA is committed to achieving maximum benefit from mobile technology whilst maintaining the necessary environment to ensure patient confidentiality and safety. This policy sets out the GHA’s criteria for the issue of mobile devices, the rules around their use, use of personal devices by staff, and acceptable use of Mobile devices on GHA premises by patients/visitors.

APPLICABILITY: The policy applies to all full-time and part-time employees of the GHA, non-executive directors, contracted third parties (including agency staff), students/trainees, other staff on placement with the GHA, patients and visitors present on GHA premises.

3.

DEFINITIONS: GHA– GoG IM & T – Mobile Device – Designated Responsible Officer –

Gibraltar Health Authority Government of Gibraltar Information, Management and Technology Mobile phone, smart phone or device, pager, any portable computer (eg laptop, tablet, iPad, PDA or camera) Any person assigned to control allocation of GHA Mobile Devices

Policy No: IMT002

Policy Version: 1.0


RELATED POLICIES: IMT Security Policy W-Fi Policy Motor Vehicle Policy GHA Policy on Photography, Video recording and filming on GHA premises

FURTHER INFORMATION: Director of Information, Management and Technology

5. SUMMARY OF THE POLICY

1.1 The GHA recognises mobile phones as an effective form of communication for clinical and operational emergencies and accept they are now are an integral part of day to day life. However, in a hospital setting they can be a nuisance to other patients and visitors and pose a risk to privacy and dignity. They can also in certain circumstances have an impact on electronic medical equipment.

1.2 The GHA is committed to ensuring that adequate communication facilities are available to its staff in order for them to carry out their normal daily duties

1.3 Electronic Device Mobility in healthcare environments assists the clinicians in delivering patient care in a timely manner by making clinical information available and viewable when and where needed.

1.4 This policy has been developed to ensure that all staff, patients and visitors are aware of the areas where the use of mobile or smartphones is authorised.

1.5 Calls to mobile phones should be limited and where possible landlines are preferred to mobiles.

1.6 In this policy, the rules surrounding mobile phones also apply to Smartphones, Data dongles and any other mobile communication or entertainment device that emits or receives a data transfer radio or wireless frequency. E.g GSM, GPRS, 3G, 4G or other wireless technology such as Bluetooth, Wi-Fi, etc.

1.7 The rules in this policy should be read in conjunction with the GHA Internet, Intranet and Email Policy, Wi-Fi Policy and IMT Security Policy.

6. OBJECTIVES OF THE POLICY The objective of the Gibraltar Health Authority in Establishing this Policy is as follows:

2.1 To define the criteria for GHA issued mobile phones and computing devices

2.2 To define acceptable use of both personal & GHA devices for patients, visitors and staff


2.3 To facilitate the utilisation of mobile computing technology where necessary.

2.4 The GHA aims to ensure peoples’ safety at work by providing clear requirements on where and when it is safe to use mobile phones. These requirements should enable staff to undertake their duties safely and at the same time protect the rights and safety of others.

2.5 Information Governance is a key risk when dealing with mobile devices. This document clarifies responsibilities to ensure confidentiality of GHA information.

7. SCOPE

3.1 This policy relates to use of both GHA supplied and privately owned mobile devices and applies to all staff who have been provided with a mobile phone for work use, or use their own mobile phone for work.

3.2 This policy applies to patients and visitors whilst on GHA premises

3.3 In all other cases, the use of personal mobile phones at work for private use is restricted to breaks and emergency situations. In the event that a member of staff needs to be contacted via their personal mobile during working hours, the phone should be switched to silent and/or diverted to the messaging service.

8. GENERAL POLICY

3.4 The GHA will offer a limited range of handsets and mobile devices based on an assessment of technical requirement, reliability, price and ease of use. Allocation of handsets/devices is based on the needs of the specific staff role. The GHA will review this choice on a regular basis to ensure that the most competitive, functional and reliable equipment is available for staff.

3.5 When first being allocated a device, staff will be required to sign the form in Appendix A acknowledging the terms of this policy and their responsibilities.

3.6 A central asset register will be held listing all GHA Medical Devices and the GHA departments or directorates that each device is allocated to.

3.7 The requirements of the law and GHA/GoG policies will be observed at all times.

9. MOBILE PHONES/SMARTPHONES

5.1 Personal Mobile Phones/Smartphones

Personal mobile phones/Smartphones can be used for work purposes where this has been agreed between the member of staff and their line manager and where such a phone is necessary and beneficial for them to do their job. To meet this requirement staff should meet at least one criteria from (a) to (c) for a mobile phone and at least two of the criteria (d) to (f) for a Smartphone.


a) Staff whose work entails predominantly lone working in the community b) Emergency out of hours staff including any staff on the on-call rota c) Staff who spend a significant amount of time out of the office and are

required to be contactable during this period d) Staff whose work regularly requires the use of email whilst: lone working

in the community / working out of the office. e) Staff whose work regularly requires access to their calendar whilst: lone

working in the community / working out of the office. f) Staff whose work requires internet access whilst: lone working in the

community / working out of the office. Applications must be made in writing to the Director of IMT via the Line Manager with authorisation by the relevant GHA Director or Unit General Manager. The organisation will not accept responsibility or liability for the loss or damage to personal mobile phones belonging to staff.

5.2 Use of Mobile Phones/Smartphones for Work Purposes

Staff should not use a mobile phone in any public area where the use is prohibited. This situation may arise within certain areas of hospital buildings. Staff should therefore be aware of any local restrictions within healthcare premises and ensure that their mobile phone is switched off if a risk exists. In line with International Standards or Best Practice it is acceptable to use mobile phones in healthcare premises, where there is no risk of interference. When using a mobile phone staff need to consider the following principles of safety, sensitivity, confidentiality and appropriateness:

It should be possible to make the call without affecting the safety of yourself and others around you, or their clinical care.

Patient confidentiality must always be respected; not all conversations are appropriate in a public place or another patient’s home.

Mobile phones should not be used for outgoing calls if a landline is available. Try to keep mobile calls brief. Personal calls should be made during breaks or in exceptional circumstances. If the call is being made in a public place, consider the content and language

used during the conversation.

5.3 Restriction on Use of Mobile Phones

With the exception of certain circumstances which are detailed within section 5.1 and 5.2 mobile phone technology must be switched off in patient care areas where treatment, examinations etc are carried out or where patients may be resting. Patients and visitors are asked not to turn this equipment on again until they are in an authorised area as indicated by signage around the GHA. Staff in restricted areas have an additional duty of care and are asked to advise patients, colleagues and visitors to switch off mobile phones when in patient areas or where signage indicates they are within a prohibited area.

To avoid the possibility of medical devices being disconnected and to reduce the potential risk of fire or electric shock patient and staff personal mobile phones are not to be charged using the patient bed head trunking electrical supply.


5.4 Use of Mobiles Whilst Driving

Using a mobile phone whilst driving can be dangerous and is contrary to the Traffic Act 2005 and the Highway Code. It is an offence to use a hand held mobile phone whilst driving a vehicle. Refer to GHA Motor Vehicle Policy.

No line manager will require any member of staff to receive or make a call on a mobile phone while they are driving. Staff are expected to switch their phone to silent and activate the messaging service. If staff decide to use their mobile phone while in a vehicle, the organisation expects them to stop the vehicle in a safe place and switch the engine off before checking their messages or making any calls.

Staff must remember they are responsible for driving safely and within the rules of the Traffic Act. Staff and not the organisation will be liable if they are found to be using a mobile phone while driving for work purposes. The only occasion where a hand held mobile can be used is for dialling and Emergency Services number in a genuine emergency and the driver judges it unsafe or impractical to stop the vehicle.

The use of hands free sets is not prohibited under the legislation. However the use of these sets still increases the likelihood of the driver being distracted and thereby involved in an accident. If this occurs, the driver risks prosecution for failing to have proper control of the vehicle because of careless or dangerous driving.

10. MOBILE DEVICES

6.1 Qualifying Criteria for GHA Supplied Mobile Devices

Mobile devices will be provided to those staff whose duties require them to be contactable or working on-line when away from their normal place of work.

Sometimes a duty will be covered by issuing a shared mobile device.

In all cases approval to issue a device must be given by the relevant Director or Unit General Manager.

Examples of need are (note: this list is not exhaustive):

• Duties that require working across multiple GHA sites

• There is a genuine need to be easily and immediately contactable during and outside of normal working hours

• Staff who work in several locations within a single GHA site

• Staff contractually required to be on call


6.2 Device Security

Smartphones, laptops and any other device that has the ability to store data must be encrypted to the Advanced Encryption Standard with a 256bit key.

All devices must have a PIN lock or be password protected

6.3 Private/Personal Data

Mobile devices provided by the GHA, are to be used primarily for business purposes.

Any faults or IT support interventions may involve loss of any personal data.

6.4 Damaged Mobile Devices

Mobile devices in need of repair should be returned to the designated responsible officer who will return them to the supplier (or GHA IT dept.) for repair or replacement under warranty. It should be noted that manufacturers’ warranties do not normally cover damage caused by misuse or neglect and that the cost of such repairs will be borne by the user responsible.

The GHA will make best endeavours to ensure a suitable replacement is issued as quickly as possible.

6.5 Device Request/Allocation Process

All requests for devices need to be made via departmental heads.

Devices such as laptops, tablets, iPads (or any other mobile computing device) that are part of a shared resource for a specific role will need to be signed for prior to allocation. On return of the device the designated responsible officer will sign that the device has been returned in working condition.

6.6 Loss of an allocated mobile device

The loss of any device needs to be reported immediately. Where a device is irretrievably lost a replacement will be procured, the cost of which will be borne by the user responsible for the loss.

11. RESPONSIBILITIES

7.1 Chief Executive

The Chief Executive is responsible for overall staff safety within the organisation and for the implementation of this policy.


7.2 Executive Directors & Heads of Departments

All senior staff are responsible for ensuring the day to day health, safety and welfare of their teams. They should be familiar with this policy and the requirements to use mobile phones safely.

7.3 Line Managers

Managers have a responsibility for the safety of their staff. They should ensure their staff are aware of this policy and of any local rules around use of mobile devices within healthcare premises

Managers need to ensure that mobile devices are recovered from staff leaving the organisation.

7.4 Staff Responsibilities

All staff should be aware of this policy and be familiar with any legal restrictions on using mobile devices. They must take reasonable care of themselves and others when operating mobile devices.

Staff are responsible for the safe keeping of GHA property. This includes keeping any mobile device secure and fully charged. The loss or damage of a GHA mobile device should be reported immediately to their line manager.

Staff need to sign for receipt of the mobile device, and to acknowledge that they have read, understood and will comply with the requirements of this policy.

Staff leaving the GHA must return their GHA mobile device to their line manager who will in turn sign for receipt of the device.

12. PATIENT CONFIDENTIALITY, PRIVACY & DIGNITY It is nearly impossible to detect whether mobile phones, most of which now incorporate cameras and video recording devices, are being used to take pictures. Additionally, with built in email and other online services capability such pictures can be transmitted anywhere within moments of taking them.

Healthcare organisations should ensure that systems are in place to protect patients’ privacy and dignity.

In keeping with the GHA Policy on Photography, Video Recording And Filming on GHA Premises it is not acceptable for GHA employees to use their own camera phones.

However some staff need to take photographs of/within buildings on site as part of their normal work. Mobile phones should not normally be used for such photographs, except in an emergency. Care should be taken not to capture patients or visitors in a photograph of a building or equipment, unless necessary.

13. COMPLIANCE WITH THE POLICY

The privacy and dignity of patients and compliance with health & safety is the duty of all staff, patients and visitors whilst on the hospital premises. For the reasons stated the GHA feels it is necessary from a clinical perspective that everyone complies with this policy.


Patients or visitors who fail to adhere to the policy will be asked to leave the prohibited use area and security may be called if they become abusive or aggressive towards staff enforcing this policy, in line with the GHA Zero Tolerance Policy. All staff who fail to comply with the policy will be reported to their line manager and persistent breaches of the policy will be dealt with under the GHA’s disciplinary procedure.


Appendix A

MOBILE DEVICE ACCEPTANCE FORM

Device Model:

Department:

Reason for Allocation

Issued To:

• I acknowledge receipt of a GHA mobile device.

• I agree to abide by the requirements of the Mobile Device policy document.

Before using the device in the event that I do not agree with the policy document, having read it, I agree to return the mobile device.

• I acknowledge my liability for the cost of any damage or loss not covered by the warranty terms of

the device • I acknowledge that in the event of loss of personal information it is not the responsibility of the GHA

to recover.

Signed:

Printed:

Date:


Appendix B EQUALITY IMPACT ASSESSMENT TOOL

To be completed and attached at the end of any procedural document when submitted to the appropriate group for consideration and approval.

Yes/No Comments

8. Does the policy affect one group less or more favourably than another on the basis of:

Race No

Ethnic Origin No

Nationality No

Gender No

Religion or Belief No

Sex No

Marital Status No

Disability No

Sexual Orientation No

Age No

9. Is there any evidence that some groups are affected differently?

No

10. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

N/A

11. Is the impact of the policy/guideline likely to be negative?

No

12. If so can the impact be avoided? N/A

13. What alternatives are there to achieving the policy/guideline without the impact?

N/A

14. Can we reduce the impact by taking different action?

N/A

Name of Policy/Guidance Notes/Guidelines assessed: Name of Assessor: Grade: Signature: Date:


5.3 Long service and good conduct medal policy

Issued by: Chief Executive

LONG SERVICE & GOOD CONDUCT MEDAL POLICY

Date Issued: Date Effective: Date of Review: Date Revised:

TBA TBA TBA

Policy Authority GHA Board

Policy Category Human Resources

POLICY STATEMENT: This policy details the criteria and procedures surrounding the award of the Gibraltar Health Authority Long Service & Good Conduct Medal. All GHA employees should be recognised for their long service and good conduct after twenty years’ service.

APPLICABILITY: This policy applies to all employees of the Gibraltar Health Authority. This policy does not directly apply to individuals not directly employed by the GHA but carrying out work on our premises, such as agency workers and external contractors.

DEFINITIONS: Stated within the main policy.

RELATED POLICIES:

FURTHER INFORMATION: Director of Human Resources

GIBRALTAR HEALTH AUTHORITY


1. KEY PRINCIPLES 1.1 Employees who have completed 20 years’ service will be eligible for the GHA Long

Service & Good Conduct Medal in recognition of their contribution to Healthcare in Gibraltar.

1.2 The award of the GHA Long Service & Good Conduct Medal carries no rights to the use

of post-nominal letters. 1.3 There is no absolute right to receive the GHA Long Service & Good Conduct Medal. 1.4 As a consequence, employees subject to penalties and/or sanctions following a

disciplinary hearing will be reviewed to consider eligibility or deferred presentation. Employees have an obligation to acquaint themselves with the GHA Long Service & Good Conduct Medal Policy.

Copies of the GHA Long Service & Good Conduct Medal Policy are to be made available via the intranet and from the Human Resources Department, 5th Floor, St Bernard’s Hospital.

2. SCOPE OF THE POLICY 2.1 This policy applies to all staff employed by the Gibraltar Health Authority, including

Government of Gibraltar employees seconded to the GHA. Seconded employees previous service in another Government Department/Agency/Authority does not count towards qualifying service for a GHA Long Service & Good Conduct Medal.

2.2 This policy does not apply to individuals not directly employed by the GHA but carrying

out work on our premises.

3. PROCEDURE

3.1 Persons entitled to a GHA Long Service & Good Conduct Medal must make a written

application to the Chief Executive by completing the pertinent application form, available to download from the intranet or from the Human Resources Department, 5th Floor, St Bernard’s Hospital.

3.2 Completed application forms must be submitted to The Secretary, GHA Staff Awards

Committee, c/o Human Resources Department, 5th Floor, St Bernard’s Hospital. 3.3 The process is administered by the GHA Staff Awards Committee who will evaluate each

application and verify the information against that held by the GHA Human Resources Department. Award decisions are based on time served (20 years by the date of application), influenced only by conduct and disciplinary record.

3.4 The GHA Staff Awards Committee will evaluate each potential recipient and submit their recommendations to the Chief Executive for approval, or otherwise.

3.5 The Chief Executive must authorise issue and confirm the suitability of each recipient.


3.6 The Secretary, GHA Staff Awards Committee will communicate to the recipient in writing whether his/her application has been approved, or otherwise.

4. ELIGIBILITY

4.1 Employees must have completed 20 years’ continuous or aggregated service in the

Gibraltar Health Authority, during which time they have had a record of continuous good conduct.

4.2 Part-time working: providing the officer works the required number of 20 years’ then s/he is eligible for the award.

4.3 Maternity leave: Maternity leave should count as qualifying service for the GHA Long Service and Good Conduct medal.

4.4 Career break: Career breaks are discounted in the calculation of length of service.

4.5 Overseas service: Overseas service does not count as qualifying service unless the officer has been seconded by the Gibraltar Health Authority.

4.6 Unpaid Leave: Periods of Unpaid Leave will not count towards reckonable service.

5. NON-ELIGIBILITY AND FORFEITURE OF MEDAL

5.1 Employees eligible for the GHA Long Service & Good Conduct Medal must be above reproach in respect of their conduct and performance throughout their service. Employees whose conduct at any time during their service has proven to fall below the standards of professional conduct or whose behaviour brings the service into disrepute, or which results in a conviction for serious criminal or civil offence(s), may be deemed ineligible to receive the medal, or for a period of service being regarded to be non-qualifying.

5.2 Employees that are awaiting the outcome of a disciplinary investigation or hearing when they complete 20 years’ service, presentation of the GHA Long Service & Good Conduct Medal will be deferred until the outcome of the proceedings are known as this may result in the employee being deemed ineligible to receive the medal.

6. MEDAL 6.1 The following diagram depicts the style of the medal.


The medal, suspended from a light blue ribbon will be round and silver-plated with a diameter of 36.6mm. The medal may be worn ‘military style’ by pinning to the chest. The medals will be presented in a presentation case.

7. REVIEW 7.1 This policy will be reviewed periodically by the Staff Awards Committee every two

years or whenever changes are deemed necessary.


Appendix ‘A’

APPLICATION for the grant of the

GHA Long Service & Good Conduct Medal

1. Persons entitled to a GHA Long Service & Good Conduct Medal must make a written application to the Chief Executive by completing PART 1 of this application form.

2. A person receiving the medal will have served in a facet of the health service for at least a minimum of 20 years during which time they have had a record of continuous good conduct. Service time need not be continuous.

3. The medal is presented by the Gibraltar Health Authority. 4. The medal will be presented on occasions or at times as designated by the Gibraltar

Health Authority.

5. The NAME OF THE RECIPIENT will be engraved on the reverse of the medal. Please ensure the spelling in PART 1 is correct.

6. Completed forms must be submitted to The Secretary, Staff Awards Committee, c/o

Human Resources Department, 5th Floor, St Bernard’s Hospital for evaluation and approval, or otherwise.

PART 1 To be completed by the Applicant

I hereby submit this application for the GHA Long Service & Good Conduct Medal as I have completed twenty years’ service in the authority.

Name* *as it will appear on the medal

Grade

Department

Date of Entry Total Years of Service

Signature Date of Application

PART 2 To be completed by the Staff Awards Committee


This application has been evaluated by the GHA Staff Awards Committee, and on behalf of the Committee, I recommend/do not recommend* this applicant for the GHA Long Service & Good Conduct Medal. (If applicable) The reason for not recommending this application is as follows:

Name: Signature: Date:

PART 3 To be completed by the Chief Executive

I approve/do not approve* this application for the GHA Long Service & Good Conduct Medal. (If applicable) The reason for not approving this application is as follows:

Name: Signature: Date:

*delete as necessary


6.1 Chief Executive Mr Chairman, Board members, this report refers to the final quarter of 2015 (October to December) and the 3rd quarter for financial year 2015/2016. The following is a summary of the Directors’ reports highlighting some of the main points which are enclosed in the main body of this document.

1. New Catering Facility

The new Catering facilities commenced operations on Saturday 10th October 2015 with the official opening taking place on Thursday 22nd October 2015. A ceremony presided by the Hon Chief Minister and Minister for Health. The new facility and service has been welcomed positively by staff and patients. The initial feedback on the quality of the food has been excellent. Together with the new Catering Unit has been the introduction of a ‘Bulk food’ service. The next stage in this transformation is the development and implementation of the new menu. It is planned to have this completed during the first half of 2016.

2. New Chemotherapy Suite

Works on this new unit commenced in November 2015, with the project expected to be completed by April 2016.

3. A&E Re-development Plan

The project to extend the A&E department went out to tender during this period. The works will provide the following additional improvements to the department;

Expanded Minors area

New Ambulance entrance

New Plaster room

Extra clinics

New changing facilities

New place of safety

Expansion of the reception area (clinical)

The design has been developed with the cooperation and input from clinical staff.

4. Health & Lifestyle Survey

The analysis of the data collected by the Health & Lifestyle survey has now been completed and is in the process of being interpreted and edited prior to being published. Publication is expected by May/June 2016.

5. Health Promotion

This period has seen numerous Health Improvement campaigns organised by the GHA’s Health Promotion Department through public events, Health Education and the publication of articles. The campaigns included topics such as;

Health and Safety in the workplace

Mental Health

World Diabetes Day

World Aids Day


Brighten your Christmas with Advice

Flu Facts

Common Winter illnesses

Stroke Awareness

Given the work being undertaken, it is very encouraging that a second Health Promotion Officer vacancy has now been filled and the new Health Promotion Officer will be joining the department early in 2016.

6. Antibiotic Awareness

A high profile campaign was organised by the Public Health Department with the assistance of Consultant Microbiologist, Dr Nicholas Cortes. This was part of the European Antibiotic Awareness week to promote awareness of antibiotics as a lifesaving resource, but one open to risk of misuse. Part of this campaign included the launch of the GHA’s comprehensive evidenced-based guidelines on antibiotic prescription for use by doctors and nurses.

7. Vaccination against Meningitis B

November saw the introduction of a new vaccine against Meningococcus B disease as part of the routine childhood vaccination programme. The vaccine will be offered to all babies to protect them against this serious disease. Meningococcus B is the leading killer of babies and young children, causing infections that come on very quickly and can leave permanent damage. This is a very safe vaccine which has been widely tested and has been administered in the UK for several months.

8. Colorimetry Service

After being approved by the Board and with additional GHA funding, the Colorimetry Service has now been fully implemented/functional with children already benefiting from this unique service. Patients no longer need to fly to UK to obtain the treatment which is another example of the GHA’s aim to repatriate services. It has cut waiting times by 50% and led to savings; but most importantly are the benefits to patients which in many cases has changed their lives.

9. Colorectal Cancer Screening Programme

The programme continues as planned with the support of the St Georges NHS Foundation Trust Screening Colonoscopists. The current programme is being reviewed in order to explore areas for improvements. Even though some cancers are being diagnosed in patients who would otherwise be asymptomatic, the response rate of the programme continues to be disappointing with an uptake of 38.1% when compared to that of the UK, which is around 60%. The Public Health Department is reviewing ways of improving this.

10. School of Health Studies

In November the first cohort of pre-registration degree students graduated. Four Registered Nurses successfully completed and were awarded a Diploma in Healthcare Practice and twelve Registered Nurses graduated with a BSc in Healthcare Practice.


11. GHA Expenditure

The financial performance report presented covers the period 1st April to 31st December 2015. As stated in previous reports, we expect a forecast overspend. This overspend is mainly being influenced by the increased pressure on many of the patient demand led budgets.

12. Estimates 2016/2017

The estimates process for 2016/2017 has been completed and submitted on time.

13. Staff Awards

The Staff Awards programme for 2015/2016 is now well underway. Board members are reminded that the ceremony is scheduled to take place on Monday 16th May 2016 at the John Mackintosh Hall commencing at 6pm. I would like to thank Dr Antonio Marin for all the work done during his time as Medical Director. Dr Marin has decided to step down after two years in post. The recruitment process for the post is in progress. To conclude, I would like to thank all the Directors, contributors and their staff who have assisted in providing these reports, without whom the achievements outlined would not have been possible. Respectfully submitted, Mr Fred Pitto CEO


6.2 Director of Public Health

Health and Lifestyle Survey

The analysis of the data collected by the Health & Lifestyle Survey has now been completed and

is undergoing interpretation and editing prior to publication. This part of the project is time

consuming as each section has to be reviewed for accuracy as well as perspective.

At the time of writing, it seems that the report will be written by the target date of 1st April

2016, but the publication of the print editions is likely to take a few more weeks.

Information Analyst

The Information Analyst has continued to service the Monthly Reporting of Government

statistics.

In line with her contractual commitment to undergo training, the Information Analyst has

commenced her distance learning Diploma Courses in Statistics and Epidemiology at the

London School of Tropical Medicine and Hygiene.

Colorectal Cancer Screening Programme

During the period spanning the months of October to December 2015, a total of 811 invitations

were mailed to eligible participants inviting them to take part in the Colorectal Cancer

Screening Programme. During this same period 804 test-kits were prepared and mailed to the

participants and 306 samples were returned to the hospital laboratory for analysis. The

following is the breakdown of the results:

261 Negative for occult blood results

26 Inconclusive for occult blood results

19 Positive for occult blood results

Of those participants invited to participate, two persons refused outright to participate in the

screening programme. In accordance with the protocol, they will be re-invited to participate in

two years.

Of the 53 invitations extended to eligible participants residing in Spain, six individuals

expressed interest in participating in the screening programme.

During this same period, three additional individuals who aged over 74 and therefore not

routinely invited group, approached the screening office requesting to be included electively in

the CRCS programme.

Participants continue to visit the screening office seeking advice on whether they should be

taking the FOB test, in view of the various medications they were taking. Other persons visit to

request replacement test-kits or to get clarification on the method.

It was noted whilst speaking to prospective participants that, while there was some new

interest as the CRCS programme became a point of conversation, in some instances during this

quarter, other family and friends were apathetic to participating in the CRCS programme


because they felt that having no symptoms made it unnecessary. Apparently, more education is

necessary because it is exactly such complacency that the screening is designed to counter.

The Response Rate of the programme continues to be disappointing at 38.1%, when compared

to that of the UK, which is around 60%. To address one possible reason that some people could

find the test kits confusing, the Public Health department has produced an instructional video

on a DVD, which has been incorporated as part of the test-kit since December 2015.

Abdominal Aortic Aneurysm Screening Programme

During the same quarter, 47 invitation letters were mailed to eligible participants, of whom 35

accepted their invitations (74% response). All these participants were issued with ultrasound

appointments.

A total of 26 reconsider letters were issued to participants who did not reply.

No expressed refusals were recorded during this period. However, 19 invitees, who did not

respond to either the invitation letter or the reconsider letter were marked as ‘Inactive’ and

notified.

Requests were received from 3 individuals aged 66-74+ years (outside the invitation range) to

take part in this initiative as elective cases. This adds to the 11 such requests in the previous

quarter. It would seem that the broadcast of the GHA infomercial promoting the screening

programme on GBC television may have contributed to the interest.

During this period, 65 men were screened. One man who was diagnosed in the previous

quarter to have a medium sized aneurysm was found that after 3 months during re-screening

the aneurysm had grown to a large aneurysm. In accordance with the medical protocol, the man

was referred urgently for vascular surgery.

Out of those men screened during this quarter, one man was found to have an undiscovered

medium sized aneurysm whilst two other men were found to have previously undiscovered

small sized aneurysms. These three men have been referred to their respective general

practitioners for further management according to the medical protocol.

As a matter of note it has been noticed that a number of individuals who have repeatedly failed

to accept multiple invitations to participate in the AAA programme readily accepted instead to

participate in the CRCS Programme, an observation that deserves further analysis.

Influenza

During October, a case of H1N1v was reported in a middle-aged man, whose condition

deteriorated rapidly, necessitating critical care and supported ventilation, but he recovered

fully. Family (household) contacts were contacted and offered vaccination.

The annual seasonal flu vaccination campaign was started. In the GHA, staff and all long stay

patients in both the GHA, Cochrane and Calpe wards were offered vaccination. To date 392

persons, both patients and staff had been vaccinated by the Infection Control Practitioners.

In December, a second H1N1v case occurred of a 61yr old woman who developed acute

respiratory distress syndrome, a complication of the disease, necessitating ventilation.


Household contacts were contacted and offered vaccination, while some staff contacts and

other family contacts also received medical prophylaxis.

Pertussis (whooping cough)

An unusual cluster of six Pertussis cases occurred in 3 adult couples during October. Cases were

unrelated and not known to each other. All were treated with antibiotics.

Health Improvement

While services for Health Improvement continue to be provided by one Health Promotion

Officer, it is very encouraging that a second health promotion officer has now been recruited

and will be joining the department in early 2016.

The following are some of the activities carried out within the department:

Public Events

• The Health Promotion Officer participated at a conference on Health and Safety in the

Workplace at John Mackintosh Hall. The presentation included dangers of sun

exposure, skin cancer and ‘the patient’s experience’

• The Health Promotion Officer supported and participated in the setting up of a Mental

Health Information Stall at Bayside Comprehensive School on Friday 9th October

2015. Several leaflets and posters were displayed and the stand was well received by

both teachers and students. Other professionals included staff from Club House,

Gibraltar, Mental health, Practice Development (GHA) and Youth services.

• World Diabetes Day 2015 campaign on Friday 13th November was held outside the

ICC Building. Members of the GHA Diabetes team and the GHA Dietetics department

also participated.

• World AIDS Day was commemorated on 1st December 2015 with a display outside the

ICC Building that included posters and leaflets on HIV and AIDS. Red Ribbons were

given out to the public. The event was covered by the Chronicle and GBC TV.

• The HPO supported the annual CAB event at the Piazza on Thursday 3rd December,

handing out “Brighten your Christmas with Advice” leaflets.

Health Education

• The Health Promotion Officer gave an interview to James Murphy from GBC on the

subject of Healthy Lifestyles for a new programme to be televised in 2016.

• Leaflets and posters on the dangers of Smoking were given to the Royal Gibraltar Police,

to address their concerns about smoking in the workforce.

• The Health Promotion Officer wrote the following articles for the Gibraltar Chronicle:

Diabetes Antibiotics Flu facts


‘Pregnancy and the Flu’ ‘Drink Safe and be safe this Christmas’ ‘Common Winter Illnesses’ ‘A stress-free Christmas’ An article ‘New Year, New You’ was also written for the Insight Magazine.

• A number of health topics were covered on Radio Gibraltar Health File, including Diabetes,

Antibiotic awareness and HIV/AIDS.

New Resources

• The department has procured two new display boards for use in Campaigns

• A new leaflet for the Meningitis B vaccine was designed and printed. This will primarily

be distributed through the Maternity and Child Health Departments

• A DVD containing the instructions for the Colorectal Cancer Screening programme for

distribution to clients was completed in December 2015.

• A new poster was designed for the Colorectal Cancer Screening Programme and

displayed at St Bernard's Hospital (Outpatients and Medical Investigation) and the

Primary Care Centre . It is planned that the poster also be displayed at other locations,

like senior citizens clubs and the Victoria stadium.

• An infomercial on Dementia has been completed for broadcasting in January.

• An infomercial on Depression and another on Antibiotic resistance are under

preparation.

Assistance to Support Groups

• The HPO supported an awareness event on Stroke organised by John Sheppard and held

on Saturday 7th November outside the ICC Building.

• The Health Promotion Officer met with Mrs Polly Lavarello founder of the ‘mum on the

rock’ (‘MOTR) website to discuss working together to enhance public awareness on

issues faced by prospective parents, new parents and other issues of concern infants

and children.

Antibiotic Awareness

A high profile campaign was led by the Public Health department through the European

Antibiotic Awareness Week (15th-21st November 2015) to promote the awareness of

antibiotics as a vital life-saving resource, but one open to risk of misuse and the long term

threat to humanity.

It included a number of initiatives with participation from across different departments of the

GHA:

A series of articles by different professionals were published in the Gibraltar Chronicle

throughout the week, covering different aspects of antibiotic use, misuse, antimicrobial

resistance, prevention of disease and control of infection in hospital.


The Gibraltar Chronicle published an interview with Dr Nick Cortes, Consultant

Microbiologist.

A number of retail pharmacies participated in the event as ‘drop off points’ for the

disposal of unused/unwanted antibiotics and other oral medication antibiotics by the

public. Collection points were located at Morrisons pharmacy, Trafalgar pharmacy,

Wesley pharmacy, the Hospital pharmacy and the Primary Care Centre. Collection bins

were dropped off at the locations and removed by GHA staff.

On Antibiotic Awareness Day (18th November 2015) a stall was manned outside the

ICC Building foyer, by GHA staff from Microbiology, Health Promotion, Pharmacy and

Infection Control displaying posters and information leaflets to raise public awareness

about antibiotic resistance and the importance of correct antibiotic use. Leaflets were

distributed to the public and advice regarding antibiotic usage given. The event was

covered by GBC TV and radio.

At the event, the public were encouraged to take part in a small quiz on antibiotics

during the day.


A new infomercial on antibiotic use and misuse was commissioning for production in

2016.

Material from the successful UK website ‘TARGET’ was used with permission from the

owners, Public Health England and the Royal College of General Practitioners.

The GHA launched comprehensive evidence-based guidelines on antibiotic prescription

for use by doctors and nurses.

Respectfully submitted,

Dr V. Kumar Director of Public Health


6.3 Finance & Procurement Directorate Developments Payroll System The GHA signed the revised new salaries software development and implementation proposal with M4 in August 2015. The project is now on track for go-live early in the new financial year. Progress continues to be closely monitored with regular meetings with the developer and in lines with the conditions of the contract, invoicing against the contract is based on successful delivery of milestones to guarantee successful delivery and implementation of the software. A test system is already installed within the GHA salaries department and as we progress with the user acceptance testing phase of the software we will be inviting other GHA stakeholders, representatives of the Government Treasury Salaries Department, Central Government IT and the Audit Office to review the new software. The Government Treasury will assess the viability of this application as a realistic option for replacing Central Government’s own antiquated Morph payroll software. If the software manages to address all GHA payroll complexities, it will potentially only require some further customisation and adaptation to the specification needs of Central Government payroll and if viable could undoubtedly provide significant software development cost savings to the Government. Estimates 2016/2017 GHA Estimates for 2016/2017 have already been presented to the Financial Secretary for consideration. Electronic Inventory Management application for Stores The development of the in-house application to fully serve the electronic inventory management needs of the main GHA supplies store continues to progress well. The piloting of the software with pantry stock items is currently on track ahead of a phased roll out. The Procurement HEO continues to lead on this initiative with eventual roll out of the application hopefully improving control of inventory and delivery of all its associated benefits in efficient and effective stock control, better cash flow management in the procuring of stock items and overall cost saving as a result of better control and less wastage and obsolescence. Following the culmination of the staff restructure in Stores, the HEO continues to work on producing an actionable Gap Analysis report to show our current position relative to the Parkhill review recommendations of some years back, and also highlighting our aims going forward. This will serve as the platform to attempt to bridge any gaps and further update on recommendations accepted, as to those already implemented and those that still need to be implemented following on from the Parkhill review. Respectfully submitted,


Mr G Teuma Director of Finance & Procurement


6.4 Estates & Clinical Engineering Directorate Report to the GHA Board of Management: 4th Quarter October - December2015. St. Bernard’s Hospital: Improving Patient Access to Main Entrance. The civil works were completed during October and the delivery and first fix of the new escalators was carried out on the 4th November. This was carried out during the night so as to keep traffic disruptions to a minimum. The final commissioning is expected during December.


St. Bernard’s Hospital: New Chemotherapy Suite Works commenced on site on the of November. This entailed demolition of redundant partitions and HVAC equipment. Some of this work has been carried out in-house to keep costs down to a minimum. During December installation of first fix HVAC and plumbing/electrics was also commenced. The project is expected to be completed for handover by the contractor during March/April. The total costs for the project including equipment is currently estimated at £160,000.

St. Bernard’s Hospital: Redevelopment Plan for A&E Following the detailed planning phase for the extension to A&E, the project has gone out to competitive tender. It is expected that the contractor will be appointed in January with works commencing in February 2016. The design is based on Clinical Staff input and the first phase is estimated at £75k. The project will incorporate the following additional features: 1. Expanded Minors Area. 2. New Ambulance entrance. 3. New Plaster Room. 4. Extra Clinics. 5. New Changing Areas. 6. New Place of Safety. 7. Expansion of Clinical reception. Completion is currently estimated for May 2016.


6.5 Director of Nursing

The Nursing Directorate’s Gibraltar Health Authority’s Board Report submission. October – December 2015 Child Health: This quarter has seen the introduction of two additional vaccines. Meningitis B has been included in the childhood programme and has required an additional vaccination session. Meningitis CY125 replaces the meningitis C and is been administered from age 13. The team will be carrying out a catch up exercise over two years, vaccinating years 9; 10; 13; the Hebrew school and the College students. Additionally this quarter the Child Health Team has assisted in another catch up exercise by administering 67 BCG vaccines to babies who were not able to receive it on discharge from the Maternity unit. Influenza vaccination programme: The overall uptake of vaccines at Primary Care and Community from October to December has totalled 1035. The figure is reduced from previous years despite the vaccine been offered almost a month earlier than in 2014. EHR: Nursing staff continue working on developing working processes and templates to incorporate within the electronic health system. Diabetic Service: The Nursing team will be carrying out an exercise to update the existing annual review register to incorporate to the EMIS recall system. Further plans include calling patients to advise of forthcoming recall before sending the letters in an attempt to reduce DNAs. Training: Several updates and training modules specific to Primary Care Nursing services have been planned with the SHS for 2016. In addition, several members of staff are currently undergoing independent studies in their specialist fields Primary Care Nursing workload Activity July to September 2015

Oct '15

Nov '15

Dec '15

Annual Total

Child Health Dept Dr's Clinic 64 54 41 Health Visitors/Nurse Team

Weighing Clinic 529 500 380 HV Assessments 236 229 237 HV Primary Visits 42 35 37 School children assessed 125 80 3919 School Health visits 0 0 0 Eneuresis Clinic 4 3 7


Immunisation Clinic 694 604 226 Total 1630 1451 906 17475 Cardiar Rehab. Nurse 114 215 140 2034 Diabetic specialist Nurse 558 690 417

7433

Nurse Practitioner 630 541 612 9116 Practice Nurses Treatment Room 999 970 1079 Phlebotomy Clinic 991 1116 958 Ear Syringing Clinic 59 62 53 ECG Clinic 114 107 157 Vaccinations 314 395 119 Nurse clinics 393 462 379 Total 2870 2112 2745 33671 Cryotherapy (Dermatology Nurse) 744 870 615

6928

MWO 104 99 118 1354 District Nursing Team Diabetic/Insulin 292 156 184 Dressings 238 225 298 Injections 55 132 151 Visits- Support/Monitoring 128 177 159

Terminal Care 0 0 1 Catheter Care 19 4 3 INR and Blood Samples 97 76 0 Total 733 770 1938 10408 Grand Annual Total

88215

Victoria Ward:

The Nurse Management team have been busy during this period with further increasing service demands from most areas. Despite these inevitable pressures the team is proud to provide high standards of care to patients and other service users addressing any concerns at source in order to improve and maintain standards of care. Training continues to be high on the priority list and staff endeavours to continue look at ways in which to maximise staff attendance.


Training undertaken by staff Safeguarding adult course for managers in November Attended by – Jessica De Santos Ward Sister Basic Awareness of Safeguarding Adults at Risk X 1 staff Nurse attended the above training. Dignity Training Attended by one of the Enrolled Nurses

Phlebotomy - Blood Department:

Phlebotomy staff and managers are exploring a blood appointment system to reduce waiting times and patient anxiety. This hopefully will soon be put into action. Staff attended the following Educational Sessions: Post Mastectomy Reconstruction and Open access follow-up after treatment for Breast Cancer presented by Mr Graham Offer (plastic and reconstructive surgeon). Basic Awareness of Safeguarding Adults at Risk attended by one of the Staff Nurses.

John Ward:

Safeguarding adult course for managers in November Attended by – Acting Sister Helena Kelly – the Nursing Directorate welcome senior nurses to undertake this training as there has been a clear need for senior nurses to be trained in this field. In house training- A course in Cannulation was attended by X4 RGNs The Acute Medical Care Module- was attended by x2 RGNs Meals Nurse Management continue to receive positive feedback about the quality of food since the bulk system has been introduced.


CCU:

Nurse management is committed to continue to provide staff with opportunities to access appropriated training and development opportunities within CCU with the support of the team. This has resulted in the following opportunities for training. Attendance at the European Society Intensive Care Medicine Congress held in Berlin – October 2015 Attended by two staff Nurses Audit Master Class course held in London – 14th November This was attended by one of the Sister of the unit. New Bodyguard 545 Epidural pumps training sessions was undertaken by 3 staff members and a total of 10 staff have attended the training sessions and the trainers have trained other staff in the unit. The Immediate Life support Course was attended by 6 members of staff SN Luis Balmaseda attended as one of the ILS instructors. Clinical Reasoning in practical assessment (Part 1 & 2) modules was held at the SHS by Kingston and was attended by two members of staff. Acute Medicine (part 1) module held at the SHS by Kingston was attended by another two staff members. Four staff CCU staff members have been involved in the development of guidelines/protocols for Non-Invasive Ventilation.

Rainbow Ward:

Academic achievement The directorate is pleased at the achievements of two staff members namely SR Sarah Smith and Staff Nurse Cary Anne Taylor. Both staff members have graduated locally with the St George’s programme. Training Neonatal workshops delivered by Kingston University lecturer for all staff SR Sarah Smith attended the EPLS Generic instructor course Equipment: A new Diabetes equipment cupboard is now placed outside rainbow clinic where patients can easily access renewal of medication & equipment. Two new trollies with drawers arrived for use in the High Dependency Unit (HDU).


Donations to the Department: Rainbow has been inundated by the kind generosity both locally and abroad throughout 2015.

The Tartan Army Sunshine appeal donated and presented a total of £5000, this went towards the Christmas party & the purchase of 2 express breastfeeding pumps (one that went to Maternity).

The Guardian Angel Foundation are currently funding the refurbishment and purchasing of furniture, Toys etc. for the playroom & multi-sensory room.

Rainbow Ward 2015 admissions to the unit according to the data collected totalled 765, an increase of 59 patients. The staff were saddened to hear of the death of Dr Steve Higgs who worked for the GHA at St Bernard’s hospital. He was a very dedicated professional always available to staff and parents/children for advice. He will be sadly missed by all who knew and worked with him. His down to earth approach made him popular both with staff and the general public.

A&E Department:

various training opportunities have been taken on by the unit staff with x 3 RGNs and x1 Enrolled Nurse attending BIPAP Non-Invasive ventilation training session held on the 25th & 26th November. A rolling programme has been developed by the team for A&E staff to attend the anaesthetic room on morning placements this will improve their knowledge and skills enabling them to assist the intensivist with intubation. This will allow for better management of the critically ill patient. The staff have also been able to attend training sessions delivered by the Consultant Paediatrician for A&E staff this is on-going. Basic Awareness of Safeguarding Adults at Risk was attended by one staff member.

Surgical Directorate:

Dudley Toomey Ward:

DTW continues to have a high turnover when compared to other wards with a mean monthly admission rate of 90 patients per month and average occupancy of 98%. During the reporting period (October- December 2015) the patient mix consisted of 8% medical overflow.


In order to cater for the care needs of all patients from diverse specialities, the following issues have continued to be tackled in collaboration/partnership with Ward managers and clinical staff:

Sr. Fennelly & Sr. Dean attended a clinical placement in St Georges University

Hospital (London) on 22/10/15 to 25/10/15 where they understudied the role

of the Ward Manager and were able to validate local practises. These visits are

part of a succession planning and leadership development initiative which it is

hoped that in the future it will gradually encompass all clinical areas.

Issues of interest identified during the visit included:

Nursing hierarchical structure (Divisions/Head of Nursing roles/strategic and operational overlap.

Electronic rostering (integration of HR/Nursing/Salaries/staff with limited access) Online mandatory training systems

Complaints documented via IT Daytex system

Practise Development themes- pressure damage and end of life care.

Active leadership development programmes (band 6-8).

Role of Modern Matron (visible in clinical areas in uniform).

Stores top-up systems. Dedicated elderly patient wards (Senior Health)


Captain Murchison:

Turnover continues to be low in view of the complex delayed discharges associated with the current patient mix. Liaison with relatives, social services and other AHP’s continues to be vital in order to establish long term plans of care in a more appropriate environment outside SBH (meeting every Wednesday afternoon). In order to cater for the care needs of the current client mix, the following issues have continued to be tackled in collaboration/partnership with ward & other clinical staff: Sr. Ivana Finlayson attended a clinical placement in St Georges University

Hospital (London) on 22/10/15 to 25/10/15 where she understudied the role of

the Ward Manager and was able to validate local practises. These visits are part

of a succession planning and leadership development initiative which will in

future gradually encompass all clinical areas.

Issues of interest identified during the visit included:

Dedicated elderly patient wards (Senior Health) & MDT/multiagency working Activities programme

Falls prevention/monitoring

Nursing hierarchical structure (Divisions/Head of Nursing roles/strategic and

operational overlap. Electronic rostering (integration of HR/Nursing/Salaries/staff with limited

access) Online mandatory training systems

Complaints via IT Daytex system

Practise development themes- pressure damage and end of life care.

Active leadership development programmes (band 6-8).

Role of Modern Matron (visible in clinical areas in uniform).

Stores top-up systems. Dedicated elderly patient wards (Senior Health)

An activities programme coordinated between CMW and VMW is on-going. From

previous satisfaction surveys conducted 92% of patients/relatives support the

introduction of an activities programme.

In an effort to continue to monitor accountability among trained staff, a list of

patients continues to be posted at ward level identifying the named nurse for


care planning purposes. Compliance will be monitored by the Ward Manager &

CNM’s responsible.

Ophthalmics:

The Ophthalmic team continue to undergo in - house training to ensure high quality standards of patient assessments, treatment and better flow of patients through the department, this with the one stop clinics has assisted in eliminating waiting times for patients requiring Cataract Extractions under L.A. Nurse led clinics have continued to impact on the number of patients that the department is now able to attend to. This includes a continuous improvement in the number of ophthalmic conditions diagnosed and treated in house and an extension in the services provided to the General Public. The Nursing staff complement has been under revision as a result of the workload and number of patients seen and treated within the department and as a consequence there will be an additional Registered Nurse joining the Ophthalmic team as from March and one of the Nursing assistants presently undergoing Enrolled Nurse Training. Additionally two other members of the Nursing Team are also undergoing additional training to enhance the Nursing skill mix and Ophthalmic expertise offered to patients currently.

Operating Theatres:

The Gibraltar Health Authority in collaboration with Edge Hill University are currently delivering an acclaimed academic module to four Registered Nurses / experienced Theatre Practitioners based on the Surgical First Assistant role as outlined by the U.K perioperative Care collaborative. The course will cover a number of topics including the legalities of the role, risk assessment, principles of the role from draping, positioning, tissue retraction, assisting with haemostasis and electro surgery. The aim being for the Nursing staff to be recognised for the role / lead they currently undertake. Following the successful collaboration between the Gibraltar Health Authority and Edge Hill university, both the School Of Health studies and the Clinical Nurse Manager for Theatres are working closely together with Edge Hill to explore the possibility of introducing the Operating Department Practitioner training locally. Historically all Operating Department practitioners have been trained and recruited from the United Kingdom as it has not been possible to do so locally. The training programme would consist of a three course at BSc (Hons) level covering all aspects of Theatre practice. The Theatre Nursing Team continue to work together with the Medical Director, Surgeons and the Anaesthetic team to maximise Theatre capacity and productivity, by utilising free sessions and Theatre 3 to undertake additional Theatre lists such as Visiting Consultants, Special needs Dentistry plus regular Ophthalmic G.A lists to reduce surgical waiting lists.


Day Surgery:

The Day Surgery unit continues to expand its services and the number of procedures undertaken within the unit with the introduction of 2 full day G.A operating sessions on Tuesdays, to reduce the waiting list for patients requiring Dental / Max-Fax surgical procedures and a G.A General Surgery list every Wednesday. At present a total of 12 – 15 L.A Dental Max/ Fax procedures are undertaken within the Monday and Tuesday sessions, with the additional provision of a further 4-6 Max-Fax G.A cases now being carried out on alternate Tuesdays. The Day Surgery Unit continues to undertake on average 85 – 95% of all elective patients requiring surgical procedures of all sub specialities. Pain clinic / infiltration sessions also continue to be undertaken as well Cardio Versions and Plastic Surgery procedures (during visiting consultant’s visits) During the period from January 2015– December 2015 a total of 2,487 surgical procedures have been undertaken within the Day Surgery Unit and a total of 2,871 patients admitted and processed through the unit (as reflected in the DSU Monthly Statistics)

Total Day Surgery % Percentage as Day Surgery Patients

JAN 189 165 87.30% 87.30% FEB 276 251 90.94% 90.94% MAR 304 268 88.16% 88.16% APR 220 183 83.18% 83.18% MAY 238 200 84.03% 84.03% JUN 224 193 86.16% 86.16% JUL 290 246 84.83% 84.83% AUG 210 168 80.00% 80.00% SEP 213 187 87.79% 87.79% OCT 242 216 89.26%

NOV 251 221 88.05% DEC 214 189 88.32%


TSSU Department:

With the increase of elective Day Surgery Procedures and provision / utilisation of Theatre 3, TSSU / CSSD has had to undergo modification and development of its services at many levels. Educationally three members of the team have undergone SSD Manager / Supervisors (DTM HTM) training at Eastwood park hospital in the UK as part of the natural progression in CFPP practices and E.U requirements. The Department has recently undergone refurbishment and updating of its Steris automated washers and decontaminations units to enable to continue to provide a streamlined service to its users which include:

Operating Theatres Day Surgery Unit Maternity Accident & Emergency Department Ambulance Services Radiology Department Dialysis All Wards & Clinics in SBH PCC ECA Ocean Views HMS Prison RGP & City Fire Brigade St Johns Ambulance

MIU/Outpatients Department:

The Colorectal Screening Programme continues with nursing actively undertaking the lead in the re-design of policies and care pathways for patients who are recalled to undergo further screening. The visiting Gastroenterologist’s from St Georges Healthcare Trust continue to provide support and teaching / training session updates on Endoscopic Practice and procedures for the Endoscopy Nursing Team to maintain service delivery to patients in accordance to NICE Guidelines and quality assured standards. MIU continue to undertake many other procedures / interventions within the department itself on a weekly / monthly basis which include all the interventions listed below;

GHA Board Report – October to December 2015

The following highlights the work carried out by GHA infection control team during this quarter:

Incidence of Pertussis in community –Bordetella Pertussis, symptoms

were that of persistent spasmodic cough and all cases proved to be

unrelated.

The team manned the ‘Antibiotic Awareness’ Campaign stand on the 18th

November along with the Microbiology department, GHA pharmacist and

Health Promotion team to promote awareness of the misuse of

antibiotics, leaflets and information give to public as well as a week -long

series of articles published in the Gibraltar Chronicle. New GHA antibiotic

guidelines were also released to clinicians.

Commencement of Hepatitis B vaccination programme to all dialysis

patients (on-going)

Flu vaccination programme commenced for GHA staff and all long stay

patients in GHA and Calpe and John Cochrane, also Prison staff and

inmates.

Medical Investigations Unit Procedures 2015

JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC Endoscopies 37 44 34 58 62 54 50 36 59 73 56 77 Stress tests 15 10 10 15 12 15 13 6 27 27 12 0 Cardiac Holter 60 60 60 60 60 60 60 27 26 60 60 60 Sleep Studies 30 30 30 30 30 30 30 30 30 36 33 30 Spirometry 16 16 16 16 16 16 16 5 3 5 4 2 Stress Echoes 2 3 0 0 0 8 10 8 14 15 8 1 Echoes 49 44 55 53 60 66 55 97 59 76 73 75 Echoes in patient 38 22 38 18 23 19 17 12

Bronchoscopies 2 2 2 2 1 1 2 2 1 1 2 1 Pacemaker checks

10 2 7 4 4 4

EEG 4 1 4 6 7 6 3 8 1 2 4 5 B/P Holters

1 1

Bone Marrows

3 3 2 1 CPAP

1 0 20 22 8

Bronchoscopies 2 2 2 2 1 1 2 2 1 1 2 1 Pacemaker checks

10 2 7 4 4 4

EEG 4 1 4 6 7 6 3 8 1 2 4 5 B/P Holters

1 1

Bone Marrows

3 3 2 1 CPAP

1 0 20 22 8

Infection Control:


The team also manned the GHA stall in support of World Aids Day on the

1st December – delivering information and ribbons to the general public

on HIV.

PPE training delivered to Environmental Agency staff.

Mandatory training and teaching delivered to first year students at the

School of Health studies.

The team also visited St Bernard’s middle school to deliver information to

school children on infection, microbes and hand washing.

The infection control team continue to routinely screen all patients

returning from other hospitals for MRSA and have commenced CRE

screening too.

Daily monitoring and surveillance of all hospital acquired infections.

The department staff also manned a stand on hand hygiene at the

Gibraltar University’s open day.

The ICT continue to attend various meetings within their remit including

meetings for Sexual Health Strategy.

The department have also been involved in commencing a clinic for HIV

patients to be seen in the GHA.

Breast Care:

The following is the Breast Care report for this period. October – December 2015 Clinical / Patient Care New patients / primary secondary breast Ca

6

Lymphoedema Appointments 11 Lymphoedema review clinics 23 Breast Care Clinic 9 IV infusions (Zometa) 17 Porta Cath Care 31 + Ivabs 7 SC Injections 16 Telephone calls 56 Patient drop ins 23 Wound Care appointments 16 Patient undergoing plastic surgery gha 4 patients seen Stoma Care 1 Home Visits 0

The breast care nurse as part of her personal development has attended the Annual Breast Care Conference in London and the Metastatic Breast Cancer Day held in London. She also attended the Breast Care Education event in October 2015 held at the Elliot Hotel local. The guest speakers at this event were from the RMH and Leicester Royal Infirmary.


Bed Management Board Report October- December 2015 1.1 The month of December 2015 as a ‘snapshot’ of the quarter has

demonstrated a continuation in high bed occupancy for adult patients at SBH.

1.2 Extra beds have been used intermittently throughout the period with an average adult occupancy was 111%. This percentage remains substantially higher than the average occupancy recommended by the DOH 2001 - 85% sealing. A sustained high overall bed occupancy level in CMW and VMW remains as a consequence of: A constant high number of long stay/complex cases populating acute

hospital beds (‘snapshot’ 88 beds held in December 2015)

Despite these issues the following efforts continue:

MDT working both on acute & long stay wards (rehab). Improving patient flow on JMW (acute medical). Proactive approach to the discharge process. DC hour’s availability to support discharge (delays on occasions). Closer integration with The Care Agency (availability of long term beds in

order to expedite patient flow). Utilisation of John Mackintosh Wing (Old SBH).

There are, however, historical ‘bottle necks’ which continue to delay the discharge process which together with an anticipated increase in seasonal demand, will in the balance of probability, cause pressure on bed availability & patient flow in the coming months. These are:

Housing/rehousing/buildings & works issues. Absence of a dedicated ‘in house’ Hospital Social Worker. Limited long term care beds (Care Agency) in relation to demand hence a

backlog in SBH/OV. A dedicated multidisciplinary team to focus on complex delayed

discharges & inpatient social care needs with a view to further develop a more robust & seamless service into the future.


1.3 Total admissions from October 2015 – December 2015 for SBH are as

follows:

Data captured on Bed Management Database. Fig 4. Total Admissions SBH January 2014- Dec 2015 (adult wards)

Total Admissions per ward 2014 -2016

0

20

40

60

80

100

120

140

Nu

mb

er

of

pa

tie

nts

ADMISSIONS DTW 115 103 114 104 112 95 102 104 100 109 93 91 111 118 117 101 113 121 109 122 118 99 90 84

ADMISSIONS Capt.M 1 10 1 0 0 2 1 4 0 1 3 1 4 2 3 8 3 3 2 1 1 1 5 0

ADMISSIONS JOHN 57 63 62 69 61 36 84 66 108 83 69 66 88 53 69 37 44 35 9* 30 32 45 36 40

ADMISSIONS VICTORIA 2 3 2 0 6 2 2 1 3 0 3 1 5 14 3 6 0 1 1 1 0 0 3 0

ADMISSIONS CCU 50 38 40 38 47 34 33 43 50 58 48 55 41 53 62 56 59 63 62 40 38 39 41 54

Jan-

14

Fe

b-

14

Ma

r-

14

Apr-

14

Ma

y-

14

Jun-

14

Jul-

14

Au

g-

14

Se

p-

14

Oct-

14

No

v-

14

De

c'1

4

Jan-

15

Fe

b-

15

Ma

r-

15

Apr-

15

Ma

y-

15

Jun-

15

Jul-

15

Au

g-

15

Se

p-

15

Oct-

15

No

v-

15

De

c-

15

Admissions all areas

866 Admissions via A&E 561

Admissions Adult & CCU

537 Admissions via A&E 389

Paediatrics

170 Admission via A&E 91

Maternity

147 Non elective 80


Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2011 to Dec 2015.

0%

50%

100%

150%

Average Occupancy 2011-Adults 97% 94% 96% 93% 92% 89% 95% 94% 96% 95% 109% 103%

Average Occupancy 2012-Adults 107% 109% 104% 82% 88% 96% 91% 87% 81% 85% 89% 92%

Average Occupancy 2013-Adults 96% 97% 98% 102% 100.70 99% 102% 97% 95% 90% 97% 92%

Average Occupancy 2014- Adults 102% 104% 96% 85.30%95.20% 95% 94% 97% 99.60%97.60%88.70% 91%

Average Occupancy 2015- Adults 96.90%99.46% 103% 100% 96.70% 102% 101% 102% 101% 110% 109% 111%

Jan Feb March April May June July Aug Sept Oct Nov Dec

Fig 3. Distribution of elderly long stay/dementia/complex-snapshot as @ 15th Dec 2015

0

5

10

15

20

DTW CAPT VICT JOHN CCU

Complex Delayed Discharges 4 10 10 8 0

Long Stay Elderly pending CA 0 15 16 0 0

Dementia 0 11 9 5 0


Fig 4. The collective breakdown of this cohort of patients is as follows. Complex Discharges

32

Elderly Long-Stay

31 Average age 83 years

Dementia 25 Identified from nursing assessment. Total Beds Held

88 130 adult beds SBH –88 = 42 acute beds available

Fig 5. Distribution of Beds SBH Dec 2015

19%

25% 24%

32%

Distribution of beds

Dementia

Complex Discharge

Elderly Long Stay

Acute Beds Available

1.3 Following re-configuration of wards, DTW & JMW continue to be the acute surgical & acute medical wards respectively. Fig 5. Total Cancellations elective inpatient surgery January 2014 to Dec 2015 due to bed shortage

Total cancellations due to beds 2014-2015

.

-2

3

8

13

To

tal N

um

be

r o

f P

atie

nt's

Cancellation due to unavailability of bed 1 0 0 0 0 0 0 0 2 0 0 0 0 0 10 0 0 3 0 0 0 0 4 3

Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec-


1.6 Patient flow out of VMW & CMW remains dependent on transfers to The Care Agency & successful rehabilitation candidates. 1.7 There have X 3 cancellations of elective inpatient surgery specifically due to bed unavailability in December 2015 and X4 in November. Respectfully submitted,

Eddie Holmes Director of Nursing Services


6.6 Human Resources Directorate

1. RECRUITMENT & SELECTION ACTIVITY Vacancies for 38 posts have been processed during the operating period covered by this report. 2. DISCIPLINARY ACTIVITY An update of the Disciplinary activity is contained in part of this Report. 3. STAFF AWARDS The staff awards programme for 2015/2016 is now well under way and the HR Department continues to receive nominations by patients, relatives and staff. The closing date for receipt of nominations is the 29th of February 2016. Discussions are also taking place with potential sponsors of the awards programme. Board members are reminded that the Staff Awards Ceremony is scheduled to take place on Monday 16th May 2016 at the John Mackintosh Hall commencing at 6:00pm. After lengthy discussions, the Staff Awards Committee has agreed on the introduction of a Long Service & Good Conduct Medal that will replace the existing long service awards. The medal will recognise the contribution to healthcare by employees of the GHA who have completed 20 years’ service who in addition have a record of continuous good conduct. The GHA Long Service & Good Conduct Medal policy has been drafted and it is anticipated that the Staff Awards Committee’s recommendations will be shortly finalized for approval by the GHA Board very shortly. 4. HR DEPARTMENT 4.1 Employee investigations law & practice As reported in my last submission, HR staff attended a course on employee investigations in the UK with the intention of disseminating the learning outcomes to others in the department through a structured presentation/workshop. The idea is also to roll-out the presentation to others in the organisation in order to provide an understanding of the legal and best practice requirements necessary to conduct employee investigations and the techniques required of the investigators. Those attending will then be included in HR’s list of potential investigators in order to assist the department in future employee/disciplinary investigations. 4.2 Annual Leave - Internal Audit The HR Department will shortly be embarking in a series of internal audits in order to inspect and check consistency in the recording and management of Annual Leave throughout the organisation. The Guidelines on Managing Annual Leave have been recently reviewed and updated, copies of which will be distributed to all those officers with the responsibility of


Managing and recording Annual Leave, in order to ensure that there is consistency in the way the GHA manages the process of Annual Leave within the principles enshrined in both General Orders and Industrial Regulations.

4.3 Policies There are a number of policies that are currently being drafted and these are envisaged to be presented to the board for approval during 2016. The policies are as follows:- Special Leave Policy This policy is intended to address and cover a wide range of circumstances when officers require paid or authorised leave of absence from work which are not covered presently by General Orders or Industrial Regulations. Mandatory Training Policy The underlying objective of this policy is to identify and state the training that the GHA considers to be mandatory and ensure that all staff are provided with mandatory training in a timely manner. On-call Policy This policy is intended to clearly set out the GHA’s and the employees obligations in relation to on-call. Respectfully submitted, Peter Linares Director of Human Resources


6.7 UGM - Hospital Services

Contents

1) Introduction 2) Facilities Management

a) Catering Services b) Domestics Services c) Hospital Attendants & Messenger Services d) Medical Records Library e) Reception & Call Centre f) Release of Records g) Minor Works

3) Ambulance Services 4) Pathology Services 5) Radiology Services 6) Sponsored Patients

End of Report


1. Introduction

This 4th Quarter saw the official opening of the new Catering Unit by the Hon Chief Minister and Minster for Health on Thursday 22nd October 2015. The facility has been welcomed positively by staff, user groups and the patients themselves.

The siting of the facility within the hospital estate brings logistical and operational improvements to the services provided and have eradicated the long standing difficulties of the transportation of meals. The main concerns of quality, temperature, taste and smell that have been the root of many complaints regarding hospital meals, have been addressed with the new bulk food system and catering assistants. Further information is included in the Catering Services section on page 4 The Estimates Submission for the financial year 16-17 was completed and submitted.

2. Facilities Management Fire Prevention GHA Senior Management continues to review and improved the general management of Fire & Emergency Evacuation. The Fire Strategy plan is nearly complete pending final reviews with a target start date of 1ST Quarter 2016. The Facilities Management team have introduced new fire prevention checks and will be improving on this in the next financial year. Fire Prevention courses for Head of Departments shall be arranged during 2016 with the assistance of the Gibraltar Fire and Rescue Service. Health & Safety The Health & Safety Committee continue to carry out Risk Assessments across GHA sites and have now developed a database to record all findings and actions taken. Heads of Departments are being informed of the Risk Assessment findings and advised of actions required within specific timeframes dependant on Risk Score. The Committee is being reviewed due to key personal changes within the departments and new dates shall be set for the 2016 period.

2. (a) Catering Services The new Catering Unit commenced operation on Saturday 10th October 2015.


This was a tremendous logistical task and delays meant that the new facility had to be fully stocked for the opening while meals had still to be provided from the old facility. There was no disruption to the services and all inpatients and outside agencies continued to receive the meals as normal. A vast array of professionals from various departments and agencies were involved and without them this important task would have not been completed as smoothly as it was. Whilst the transfer from the old facility to the new one was being undertaken a separate team from the GHA and the GoG Technical Service Department was at the same time vacating and decommissioning the old facility to make way for another Government project. General There has been a great uplift in organoleptic attributes. Food is of a better quality in general and temperature which is the main problem encountered by most similar operations in UK is a thing of the past. All food provided to wards at St Bernard`s Hospital are probed for temperature and this logged into a special catering file located in every single ward which can be seen by anyone requesting it. Quality has improved without a change in menu since we moved into this facility however, some new menu items have been introduced with positive feedback. Bulk food service has the advantage that all foods are suitable for it. Therefore now while designing the new menu the meal distribution system does not stop us from being able to supply anything making such menu compilation much easier and way more varied. The new menu will be finished in the 1st quarter of 2016 and presented to the dieticians for approval after which can be implemented. Meals Provided for the period October to November 2015

Environmental One vehicle has been taken of the road therefore reducing carbon emissions and running costs. At present we are gathering figures to see to what extent the new facility stands in comparison the old one in terms of Gas, Water and Electrical consumption. The amount of 12v batteries taken out of service is 48. These had to be changed twice yearly therefore 96 batteries are no longer disposed off. These batteries were part of the former meal distribution system. A very important consideration to the environment and to cost is the substantial savings made in terms of electrical consumption. This is presented in the comparator below:


Bulk Food Service This service means that food is transferred in large containers known as gastronomes from kitchen to point of service. The positive Choice at point of consumption Pleasant Smell Heat retention meaning better temperature Customised portions Food is safer as it`s easier to control the temperature of a larger gasstronorm container than a plated meal. Second servings can be provided Possibility to combine different options available Less wastage due to higher food intake Temperature Items of food which are sent to wards and for other services are probed for temperature and these findings recorded in order to comply with best practice not happy only with this but food is also probed and findings recorded at arrival to wards. Meals are plated on a four at a time basis to ensure that temperature is not lost between serving and bedside. Ward Catering Assistants Eighteen new supply domestics have been recruited and trained to undertake all catering services duties in the hospital wards. This role may be developed further in the future. Training The department has seen an intensive programme of training that will be continued as part of the strategy of the new Catering Unit. Training included, induction, familiarization and the safe operation of catering and cleaning equipment.

Hobart Induction

Bonnet Induction

ELRO Induction prior to occupation of new premises and retraining on

February 2016

Thermomix Induction

SUTTER Cleaning training with certificate

Old Facility New Facility Perio

d Total Perio

d Total Saving for new

facility Oct-14

£7,989.60

Oct-15

£5,102.88

£2,886.72

Nov-14

£7,989.60

Nov-15

£5,850.13

£2,139.47

Dec-14

£7,109.60

Dec-15

£3,875.63

£3,233.97

Jan-15

£8,435.10

Jan-16

£3711.13

£4,723.97

Total £12,984.13


Karcher Induction

Vianen Ventilated ceiling operations and troubleshooting

Feedback Positive feedback has been the case throughout but like in everything we cannot please every individual taste and at times service users feel that we should. At the moment we are offering choice at point of consumption which is an enhancement from the previous meal service. There have been issues brought to my attention as complaints but when investigated these were more to do with personal likes and dislikes. Patients wishing so are enjoying a second serving of food too. Sandwiches are being made at ward end in order to guarantee freshness. The department is considering conducting routine surveys at ward levels to find out how inpatients feel about the meals being served to them.

2. (b) Domestics Services

General

Improvements and initiatives introduced by the Domestic Service Management in this last quarter include:

Dementia Day Facility

The Domestic Services team have had on site meetings in order to measure up for window curtains. Fabric has been selected and purchased and the GHA seamstress team are currently manufacturing the curtains.

A staffing plan for Dementia Day Facility has been presented on a phased

programme.


2. (c) Hospital Attendants & Messenger Services

Security Door Access System The access grouping in the new door access system has been finalised and the Facilities Management team are currently preparing all the new ID/Access cards for distribution. Final commissioning is expected by 1st Quarter 2016 and change over to the new system will be phased.

2. (d) Medical Records Library

Grooming Health Record File/File Tracking Filetrail has now been implemented and commissioned for all external users ie Ward/Clinic clerks and all patient notes are being tracked on the new system. This tracking and paper management system will also be introduced in Mental Health. We are still faced with challenges and difficulties as this is a manual system and fully dependent on individual users tracking file movement accordingly. Accident & Emergency Ward Clerks The ward clerks recruited in April this year have integrated well in the department and are operating a 24/7 administrative support in the Accident & Emergency Department. Efficiencies in responding to the public and providing patient records, registration and accounts function has been improved due to the quick response having staff on site. All staff are being updated and trained in all functionalities of the role. There has also been a substantive saving in overtime costs as staff previously on on-call duties had to attend when recalled in order to cover this role. Medical Health Record Library The Medical Records output performance for outpatient consultations continues to be maintained in the high 90% success rates. This can be seen on the graphs from our internal audits. Table 1 Table 1.

The figures and performance outlined above can be contrasted with the output achieved in terms of the volume of requests and the actual number of Records delivered within the given period. Table 2


Table 2.

2. (e) Reception and Call Centre

As per my previous report the Call/Centre staff continue to report on daily cardiac arrests call-out. Weekly reports on the response rates are submitted to the Clinical Director Anaesthesia, Intensive Care and to the Deputy Director of Corporate Services. Staff have been trained on EMIS WEB the new electronic patient record system introduced in PCC. This system is now being used to schedule outpatient appointments at the PCC. Call Centre staff assist with appointment booking at peak hours.

2. (f) Release of Records

Statistics on the number of Subject Access Request for release of medical notes received from Oct 2015 to Dec 2015 are as follows. Monthly average for the 4th Quarter = 58.

Oct-15 Nov-15 Dec-15

8 9 8

Shipping Agents 0 0 1

2 0 0

1 3 4

0 2 8

73 61 40

Lawyers

Insurance Companies

DSS

RGP

Patients

Requests

3. Ambulance Services

The Gibraltar Health Authority’s four paramedics have completed their first year of practice which has resulted in tangible benefits for pre-hospital care in Gibraltar, particularly in the field of analgesia. Additionally, Emergency Medical Technicians (EMT’s) have completed their fourth year of being able to administer a range of safe and effective medications in emergency situations. These emergency medications include aspirin, IM adrenaline (Epipen), GTN spray, Glucagon, salbutamol and atrovent. Table 5 provides a summary of the annual usage:


EMT MEDICATION ADMINISTRATION 2015

2015 salb atrovent GTN aspirin glucagon Epipen January 13 2 8 11 0 0 February 7 1 6 7 0 0 March 7 3 7 9 0 0 April 3 1 8 7 1 0 may 3 0 3 5 3 0 June 3 1 0 1 2 0

July 5 1 5 7 0 0 August 4 0 6 5 0 0 September 6 0 1 4 2 0 October 5 1 1 2 1 0 November 4 0 3 7 0 0 December 11 3 8 7 3 1

TOTAL 71 13 56 72 12 1

PARAMEDIC MEDICATION ADMINISTRATION 2015

226 patients have received paramedic medications throughout 2015, representing approximately 6.5% of the 190 call volume and this figure is consistent with UK ambulance statistics. From the data above, as well as from experience, analgesia is clearly the primary medication benefit provided for by paramedic practice in 2015. The patients’ results and feedback are clear evidence that pre-hospital pain management is a key factor in improving the patient experience, with over 60% of those receiving analgesia reporting at least a 50% reduction in their pain score . Being able to transport patients with manageable pain levels relieves stress levels for patient, relatives and ambulance crews, as well as reducing the pressure for nursing staff on arrival at A&E.

An inter-departmental initiative which has proven beneficial is the ability of paramedics to obtain blood samples from patients prior to arrival at A&E. This has permitted lab results to be analysed quicker and without the need for additional venupuncture, Apart from advanced medications, paramedics have started working from a response car when resources allow. This maximises the availability of the paramedic to back-up both GHA and GFRS ambulance crews, as well as being available as a solo responder for non-conveyance and mental health assessments.

Meds Jan feb Mar April May june July Aug Sept Oct Nov Dec TOTAL

Amiodarone 0 0 0 0 0 1 0 0 1 1 0 2 5

Adrenaline IM 0 0 0 0 0 0 0 1 0 0 0 0 1

Adren IV/IO 1 1 0 1 1 1 0 0 4 1 0 3 13

Atropine 0 0 0 0 0 0 2 1 0 0 1 0 4

Nalaxone IM 0 0 0 0 0 0 1 0 0 0 1 0 2

Diazepam 1 0 0 0 0 1 1 2 0 2 0 0 7

Odansetron 5 6 3 9 10 10 6 13 2 6 9 15 94

Glucose IV 1 0 1 1 0 0 0 0 3 0 0 1 7

Paracetamol 6 6 7 13 11 10 7 11 3 12 8 4 98

Morphine 6 5 6 6 8 7 4 8 3 5 8 13 79

Chlorphen 0 0 1 1 0 0 0 0 0 0 0 0 2

Saline 8 1 3 4 8 0 7 8 1 4 4 7 55

Total Meds 28 19 27 35 39 30 28 44 17 31 31 49 378

total patients 23 11 14 22 22 16 17 25 16 17 17 26 226

Analgesia 10 9 9 14 13 9 9 11 6 12 12 14 128

PS red >50% 70% (8/9)87% (6/9)67% 29% 46% 55% 68% 55% 33% 50% 83% 79% 61%


New Statistical Data Available

Statistical data now forms part of Crew Leader’s corporate responsibilities and as a

result a new system has been implemented which provides important information

regarding emergency deployments zones. The system will soon be upgraded in order to

provide further data such as time deployment patterns, data analysis, paramedic

interventions and paramedic response vehicle activity.

Main Zone Deployments

Month *Oct Nov Dec Total

Gib Port 7 5 6 18

North Area 60 63 71 194

Eastside Area 9 5 14 28

Westside Area 197 124 159 480

South District 116 74 95 285

Upper Town 33 24 47 104

Town Area 89 84 82 255

Frontier/Airport 7 6 3 16

Nature Reserve 3 2 3 8

*October Data includes 6 x days from September

Summary of Patient taken for Scans and or Transfers to Spain - October 2015 – December 2015

Destination Oct Nov Dec

Algeciras 44 38 24

Benalmadena (Xanit) 32 38 30

Cadiz 0 2 2

Gibraltar 8 6 4

La Linea 0 0 0

Malaga 4 1 2

Seville 0 0 0

Jerez 2 6 0

Marbella 0 0 0

Totals 90 91 62


Summary of Local Patient Transfers - October 2015 – December 201

Emergency Ambulance Deployments - October 2015 – December 2015

Advanced First Aid Training The GHA Ambulance Service and Royal Gibraltar Police continue strengthening their links and close collaboration. On this occasion GHA Ambulance Service provided Advanced First Aid training to 34 members of the RGP Firearms Department. The training included:

Basic Life Support & Automated External Defibrillation Haemorrhage control using appropriate tourniquets Pressure & Blast dressings Treating sucking chest wounds Summary on internal & external ballistic & in depth terminal ballistics 4 x stages of blast injury

4. Pathology Services

Beta 2- macroglobulin The Department has introduced the in-house analysis of Beta 2- macroglobulin (B2M) which is used as a tumor marker for some blood cell cancers. It has been associated with the amount of cancer present and provides additional information about prognosis for the patient. B2M may be requested to help determine the severity and spread (stage) of multiple myeloma, to help evaluate the prognosis of cancers such as multiple myeloma and lymphoma, and to evaluate disease activity and the effectiveness of treatment. When someone has been diagnosed with multiple myeloma or lymphoma, that person is likely to have a poorer prognosis if the B2M level is significantly elevated. For monitoring treatment, decreasing concentrations over time in

Month Total Average per day

October 135 6

November 130 6

December 96 4

Month Total Average per day

October 420 14

November 387 13

December 480 15


someone with multiple myeloma indicate that the person is responding to treatment. Stable or increasing levels indicate that the person is not responding.

5. Radiology Services

The Chief Minister and the Minister for Health unveiled a plaque to commemorate the upgrade of the CT Scanner on 11th November 2016.

All radiographers are now fully proficient with the new the Ingenuity 128 slice CT scannerwith dual injector pump. The Department held a core user Train the Trainer course for the new

Computerised Radiology Information System CRIS® (expected to be fully

operational this April 2016).

In November 2015 the Department commenced CRIS® cascade training,

including demonstrations for future Radiology users, system management

training and voice recognition training for system administrators.

There is an ongoing Ultrasound Scan initiative lists with an aim to reduce

waiting times in this modality.

A total of 14 extra lists have been undertaken = 192 patients which has led to a

slight reduction in the waiting time for a ‘routine’ scan to 5 weeks and made a

significant reduction in the waiting time for an ‘urgent’ scan to 1 week or less.

CPD

A Radiologist attended a Breast Cancer Conference locally.

A Radiologist successfully completed their annual appraisal.

6. Sponsored Patients Services

The Sponsored Patients Department activity continues to grow based on the demand for tertiary services. Following an internal review, the Hon Minister for Health published the changes in sponsored patient allowances in his Budget Speech of 23rd June 2015. As from the 1st of July, the weekly maximum allowance was increased from £427 to £504, with a corresponding 18% increase in the allowances for those

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staying at Calpe House. Other improvements included greater flexibility in arranging return dates and escort conditions for the children and the elderly. These much overdue changes have been discussed with and welcomed by patient groups. A new patient escort internal policy and payment process was introduced and has seen benefits in the way that escorts are appointed and remunerated. International transfer protocols for emergency transfers of patients to specialist hospitals in Spain and the UK have also been arranged including retrieval teams for paediatrics and high dependency critical patients.

October to December 2015 Statistics

Spain Referrals 1180

Spain Patients 465

UK Referrals 466

UK Patients 348

Flights 1541

Air Ambulance (Atlas Jets)

3

Holiday Dialysis 2

GHA Ambulance Request

151

UK Taxi Requests 636

Tourists Insurance Spain

6

Visa Applications 7

Retrospective Sponsorships

0

Translations (Link Europe)

137

Assessments per day Average 3 - 4

End of report. Respectfully submitted,

Darion Figueredo UGM – Hospital Services


6.8 UGM – Primary Care Services

GP CLINIC ACTIVITY

Monthly Attendances to Primary Care Centre (October, November, December 2015) Within the past three months a total of 33,184 patients have been seen at the Primary Care Centre by General Practitioners, an increase of 4,238 patients. It should be noted that EMIS was introduced in June 2015 and following arrangements were made to achieve a smooth transition re allocation of appointment slots. These were as follow: As from the 25th September to the 11th December, 12 appointments were made

available per session per General Practitioner, with 2 overflow appointments released for emergency cases again per session per GP. This allowed the GPs 4 administrative slots per session per day.

During the Christmas period from the 14th December till the 31st December, 14 appointments were made available per session per General Practitioner. Including 4 overflows released for emergency cases, again per session per GP. This allowed the GPs 5 administrative slots per session.

As from the 1st January 2016, amendments have been made to the appointment system once again, therefore at present we are able to provide 12 routine appointments, 3 emergency overflow slots and 1 critically ill slot to be used in the case of an emergency requested by the nurse in charge to the GP.

Below is a view of monthly patient’s attendances at the PCC per areas and Locum GP during the months of October, November, December 2015.

(Figure 1) (Figure 2)

DNA appointments at the Primary Care Centre Three methods for cancellation of appointments are in use for patients should they not be able to attend.


- Voicemail service: 200 43331 - E-mail: www.gha.gi/cancel.php OR - Appointment line: 200 52441

Not with standing, a total of 1,460 appointments have been missed between October, November and December 2015 as can be seen in Figure 3+4. In comparison to July, August and September 2015 the PCC has seen an increase of 99 missed appointments by patients at the Primary Care Centre by areas and Locum General Practitioners.

(Figure 3)

(Figure 4)

Weekend Attendances to Primary Care GP Emergency Clinics A buddy system is put in place to be able to manage the increase in demand, this is a non-contractual but remunerated arrangement by GP’s. The GP’s cover each other within the same group. Should a GP from their group not wish to provide cover then a GP from another area is approached. Should there be a strong likelihood on the day that clinic attendances will exceed 35 the buddy system will be activated by the GP/sister in Charge. Below you are able to view the amount of patients seen at the Primary Care Centre on the weekend emergency clinics during the months of October, November and December 2015.

http://www.gha.gi/cancel.php


(Figure 5) (Figure 6) Nurse Practitioners attendant appointments Figures 7&8 show nurse practitioners attended appointments between October and December 2015.

(Figure 7)

(Figure 8) Nurse Practitioners DNA appointments As can be seen below 278 appointments have been lost during the months of October through to December 2015. In comparison to the months of July, August and September 2015, 304 patients have missed their appointments.


(Figure 9)

(Figure 10) House Calls Figures 11+12 below shows the amount of house-calls recorded during PCC working hours, a total of 752 patients have been booked in for house calls during the months of October, November and December 2015. No record is kept of house-calls requested after PCC working hours. In comparison to the months of July, August and September 2015, 651 house calls have been booked. This shows that there has been an increase of 101 house calls during the past three months.

(Figure 11) (Figure 12) GP Well Woman Clinic The well women service is provided by one GP on a part-time basis and by nurse practitioners. A total of 604 patients have been seen by the women’s health clinics (Fig 13&14) between the months of October to December 2015.


(Figure 13)

(Figure 14) GP Well Woman Clinic DNA’s As can be seen from figures 15&16, 198 appointments were missed.

(Figure 15)

(Figure 16)


Audiology attended appointments Below you are able to view the statistics regarding the amount of patients in which have been seen at the Audiology department at the Primary Care Centre. As we can see from the charts below, a total of 480 patients have been seen during the months of October, November and December 2015.

(Figure 17) (Figure 18) Audiology DNA appointments As can be seen underneath during the months of October, November and December 2015, the Audiology Department at the Primary Care Centre has had 21 patients miss their appointments.

(Figure 19) (Figure 20) Occupational Therapist Seen Patients As can be seen from figures 21+22 below, during the months of October, November and December 2015. The occupation therapist department at the PCC have seen a total of 2193 patients.

(Figure 21)


(Figure 22) Occupational Therapist DNA appointments As from the statistics available we have been able to find out that during the months of October, November and December 2015 there has been a number of 7 appointments missed during the months mentioned.

(Figure 23 )

(Figure 24) Paediatric occupational therapists seen patients As from the statistics available we have been able to find out that during the months October, November and December 2015 there has been a number of 2046 patients seen at the Paediatric occupational therapist department at the PCC. As from our findings during the months of July, August and September 2015 the paediatric occupational therapists had seen 1254 patients. This shows that there has been an increase of 792 patients seen within the months of months October, November and December 2015.


(Figure 25)

(Figure 26) Paediatric occupational therapists DNA appointments As can be seen below, we have been able to find out during the months of October, November and December 2015 the Paediatric occupational therapists have had an amount of 19 missed appointments.

(Figure 27)

(Figure 28) Physiotherapy Appointments Attended


As from our findings the physiotherapy department at the PCC have been able to see 2343 patients during the months of October, November and December 2015.

(Figure 29)

(Figure 30) Physiotherapy DNA Appointments Below in figures 31 &32, you are able to view the results we have obtained regarding the amount of lost appointments within the physiotherapy department at the Primary Care Centre. As a result, a total of 66 appointments have been missed during the months of October, November and December 2015.

(Figure 31) (Figure 32) Paediatric physiotherapy Appointments Attended As can be seen from Figures 32 & 33, these are the results we have obtained in which show the amount of patients seen within the paediatric physiotherapy department at the Primary Care Centre. As a result a total of 812 patients have been seen during the months of October, November and December 2015.


(Figure 32) (Figure 33) DNA Paediatric Physiotherapy Appointments We have obtained the following results for the months of October, November and December 2015; unfortunately, 85 patients have missed their appointments within the Paediatric Physiotherapy Clinic.

(Figure 34)

(Figure 35) Speech and Language Attended Appointments As from our statistics Speech and Language department at the Primary Care Centre have seen a total amount of 2143 patients during the months of July, August and September 2015. Below you are able to view the amount of patients seen during the months of October, November and December 2015 (2869 patients). As you can view, there has been an increase of 726 seen patients within the three months.


(Figure 36)

(Figure 37) DNA Speech and Language Appointments As can be seen from the charts below we are able to identify that the Speech and Language Department within the Primary Care Centre have had an amount of 357 missed appointments during the 3 months. This is a substantial amount of lost appointment in which could be used by other patients in need.

(Figure 38)

(Figure 39)


Dental Department The department continues to operate at near full capacity both at PCC and SBH, with visits to St Martin’s School, Dr Giraldi Home and the prison.

Appointments DNA October to December 2014 5427 20% October to December 2015 4956 18%

There has been an increase in the number of general anaesthetic sessions made

available for those patients with special needs; this has decreased their waiting time.

Optometry Department Incoming Referrals originating from outside the Ophthalmic Unit 66 outside referrals received, 13 more than that of the last quarter. Referral Category Oct Nov Dec Total Child refraction 1 5 2 8 Adult refraction 2 8 3 13 Adult out patient 0 8 3 11 Diabetic Retinopathy Screening 12 19 26 57 Glaucoma Screening 3 9 5 17 Low vision 0 0 0 0 Total 18 49 39 66 Caseload Caseload for this quarter comprises of 32 % new patients, and 68 % reviews. DNA rate was 21% Next available appointment as of today’s date of submission (8/1/16) varies according to clinic type: Refraction: 4 months, Outpatient appt: 2 months, DR Screening: 3 months. Clinic Total this Qtr Child Refraction 24 Adult Refraction 131 Joint Child Clinic with Orthoptist 59 Adult out patient 33 Post op Refractions 45 Diabetic Retinopathy Screening 271 Diabetic Retinopathy Management 8 Glaucoma Screening 81 Glaucoma/OHT Management 40 Low Vision Refraction 21 Low Vision Aid assessment 5 Clinically required Contact lens appts 34 Spectacle Rechecks 1 Total 753


Refraction Services As per last board report. Low vision Services This quarter there has been only one new CVI registration. For 2015 there has been a total of 10 Certificate of Visual Impairment (CVI) registrations 3 of which were for severe sight impairment. The table below outlines the causes of visual impairment. This makes a total of 113 CVI registered individuals for the population of Gibraltar at the year’s end. Cause of Visual Impairment Total 2015

Brain & CNS Neoplasia 1

Hereditary Retinal Dystrophy 1

Visual cortex disorder 1

Glaucoma 4

Age Related Macula Degeneration 2

Optic Atrophy 1

Degenerative Myopia 1

Total 10*

*one Px with ARMD and Glaucoma combined hence 10 total instead of 11 2015 Low Vision Statistics Oct-

Dec Low vision aids items loaned 29

patients loaned LVAs 20

LVAs returned 1

Unserviceable LVAs 0

Referral to ROVI 3

Px declined ROVI referrals 3

CVI Registration 1

Px declined CVI registrations 0

Training Optometrists attended a refresher lecture on binocular vision provided by the Ophthalmic Unit’s locum Head Orthoptist. This was open to all local optometrists, and registered with the UK’s General Optical Council, for the optometrist to gain CET points for their continued registration.. Patient Appliance Policy - Optical During this quarter there was one case of GHA refunding of spectacles, due to a prescribing error. GHA funding of spectacles due to exceptional circumstances Cause :- Oct Nov Dec Total Prescriber error - - 1 1 Intolerance - - - - Surgical Intervention 1 - - 1 Ocular Disease - - - - Loss due to disability – Child - - - - Loss due to disability – Adult - - - -


Total 2 Complaints No official complaints have been received or clinical incident reports filed this quarter. Orthoptics: 1st October – 31st Dec 2015 Recent developments:

No change in staff complement.

Main Clinics still running. Despite the recent enormous increase in demand for Orthoptics leading up to the Christmas break, the department is pleased to say waiting times for Orthoptics are under 6weeks and urgent referrals seen same day/day after as appropriate. It is anticipated that waiting times for Orthoptic will return to under 4wks by Easter.

ORTHOPTIC-LED CLINICS April-JuneJul - Sept Oct - Dec

Paediatric Joint Cyclo 50 61 53

Adult Visual Fields 103 104 126

Orthoptic Clinic 121 219 179

Colorimeter Patients 1 3 2

Vision Screening 63 48 280

50

100

150

200

250

Paediatric Joint Cyclo

Adult Visual Fields

Orthoptic Clinic

Colorimeter Patients

Vision Screening

OVERVIEW OF ORTHOPTIC-LED CLINICS: 4TH QUARTER 2015

Colorimetry service is fully implemented. Thanks to injection of further funds

by the GHA, the service is now fully functional with children already benefiting from this unique service offered by the Eye Unit. The successful implementation show the following benefits: - Patient no longer need to fly to mainland UK to obtain the treatment (this

alone has cut waiting times by at least 50%). Savings made from this can now be used to improve the service to the people of Gibraltar. To this end, the GHA recently injected more funds into the service so that orders that were being delayed could be processed within 7days.

- Patients who have benefited from this service have said it has “changed their lives” or “my self-esteem has been restored”; “it has put me back at equal footing with other pupils at my school”; “I am no longer being teased at school”; “our son has got his life back through the GHA funding of this service”; and so on

The Ophthalmic stroke service: The new Orthoptic-led stroke service has

already benefitted some patients (with patients now able to have an eye

appointment within 3wks of referral). The initiative is part of a deliberate

strategic push to get AHPs to work more closely together so that more patients

can access the extensive and diverse service that AHPs provide.


Undergraduate students from two leading UK universities have continued

to rate Gibraltar Ophthalmic unit as a leading preferred location for

Orthoptic clinical placement. The placement, pioneered by Michelle Brown,

has received record placements in 2015. This unique success, though led by the

Orthoptist, continues to be the result of the combined efforts of ophthalmic

nurses, optometrists and ophthalmologists in the Eye Unit. It has continued to

raise the profile of the Eye unit, which is inspiring locals to consider a career in

Orthoptics thereby securing local recruitment in future.

Dietetic Department

The department of Nutrition & Dietetics have seen a total of 773 patients during

the months of October to December 2015.

Staffing

Interviews for the vacant maternity post were held on the 23rd November 2015.

We have chosen a senior dietitian to cover this post and we are awaiting the

necessary police and reference checks prior to her starting. She will also have to

work her 1 months’ notice period and is expected to be able to start in January.

We currently have a locum dietitian providing cover for this post.

Education/Training

A new development has been the restart of the paediatric dietitian pursuing her

Clinical Research PhD. This is funded by the department of Education and is in

conjunction with the University of Southampton.

Nutrition Support

The number of patients receiving enteral tube feeds continues to increase. We

are still awaiting the authorisation for dietitians to be able to prescribe

nutritional products to community tube feed patients.

Occupational Therapy

1. SBH IN-PATIENTS SERVICE:

In–Patient OT Referrals:

July - Sept Oct – Dec

2015 105 72

The OT Labourer has been seconded for 20hrs / week to the Dept, he continues to assist staff with equipment cleaning / store management / deliveries / collections and joint visits. This has become as essential addition to the service, saving on therapists’ time and has alleviated the need for two therapists going on visits to fit equipment and covers all of the OT Service areas. OT Labourer – Number of collections/deliveries + joint visits:

*This

Oct – Dec Days lost for other dept cover

2014 52 -

2015 96* -16 days


does not include cleaning and store time

Hand Therapy Referrals continue to slowly increase. The OT / Hand Therapist

now works closely with the out-patient physio service and plans are being made

to make stronger links with the out-patient consultant clinics and with the

visiting Rheumatologist, this will mean an expected further increase in the

referral rate over the next year as more Consultants / Drs become more aware of

the available service.

Hand Therapy Referrals:

2. COMMUNITY OT SERVICE:

Having Locum cover for the Sen II OT vacant post, OT Labourer Support and the

additional 11hrs / week of OT Assistant time from SBH it has enabled the team

to work steadily through the waiting list and for this period it has now been

brought down to approx.4 months see stats below for referral details.

October 2015: Total waiting = 50 (increase by 3 persons) Waiting time = 28 weeks (approx.7 mnths) for routines (increase by 2 weeks) Nov 2015: Total waiting = 38 (decrease by 12 persons) Waiting time = 16 weeks (approx.4 mnths) for routines (decreased by 12 weeks) Dec 2015: Total waiting = 28 (decrease by 10 persons) Waiting time = 16 weeks months (approx. 4 months) for routines.

The OT with a special interest in Palliative Care continues to take the appropriate referrals from Community OT, attending the monthly Palliative Care meetings and in regular contact / visits with the CRC.

3. MENTAL HEALTH:

The winter months have bought some changes in the Arc Department. Our

Occupational Therapy Technician retired at the end of October 2015 after many

years of service. This post has been advertised and should be filled shortly.

Oct - Dec

2014 13

2015 19

Urgent 2

Mediums 9

Routine referrals 5

Urgent 5

Mediums 9

Routine referrals

13

Urgent 3

Mediums 7

Routine referrals

2


Christmas activities have included arts and crafts, meals out with both inpatients

and community patients and a ward party to celebrate the Three Kings. Charity

money has enabled us to facilitate these activities.

*The ARC stats include both group settings and individual work facilitated either in the hospital setting or in the patients’ home or community.

There has also been a steady increase of referrals and patients seen from

Horizon ward (Acute Ward) since our move to the new hospital. There are now

two afternoon sessions (Tuesdays and Thursdays) specifically for patients from

Horizon ward, to ensure they are able to make use of the Arc to facilitate their

needs and recovery. The use of the computers is very well used by these

patients.

Community patient contacts have increased over this period and have been seen

in a variety of settings. These included the relaxation sessions held in Cardiac

Rehabilitation and the Drug and Alcohol Unit (Bruce’s Farm), as well as the

Coaling Island Lunch Group and individual sessions. The Coaling Island Group

now has 5/6 community patients who attend regularly.

4. PAEDIATRICS:

Our Basic Grade OT received her most deserved re-grade to a Sen II OT which

allows her to continue her work at a higher level, to further develop her skills,

take on additional responsibility and assist with service development.

A project has started in liaison with Westside School in order to assess and

advise on wheelchair access for its pupils and visitors.

All OT staff completed the GHA DCRT Conflict Resolution 1 day course held in Dec and eagerly awaiting the dates for the DCRT 3 day follow up course to be released. Speech & Language Therapy Staffing During this period there have been no changes to the staffing complement of this department. SLT Service Map as follows:

ARC* Dawn Ward (Rehab Wd)

Average number

of daily contacts

19 contacts 10 contacts


Training During this period this service has benefitted from the following:

Both Paediatric Senior II therapists attended Child Protection Tier 1 training

Acting Head and Senior II Paediatric Special Needs therapists attended Safe

Guarding Adults Training.

Acting Head attended National Autistic Society Conference on Communication, in

Leeds November 2015. Attendance at this event was self-funded.

Senior II Special Needs attended Managing Conflict Training.

During this period this service has delivered the following training: 4 week, 12 hour Makaton Training workshop for parents and carers during

November and December 2015.

Floor time/ Sensory Bags Workshop to staff at St Martins School.

Paediatric Mainstream Caseload During this period the focus of this service has been to reduce waiting time for therapy and to ensure that the service is equitable across schools. This is being successfully tackled by offering blocks of therapy both in school and at the PCC. Blocks enable frequent rotation of provision and help prevent “bed blocking” of services. DNA’s to the outpatient service are being tackled with reminder letters making families responsible for re-engaging with the service. The campaign appears to have been successful and the high number of failed attendances has recently reduced. Paediatric Special Needs Caseload The SLT provision to Learning Support Facilities (LSF) within mainstream provision in schools continues to develop and during this period our department has been involved in the setting up of weekly EMDT (Educational Multi-Disciplinary) meetings for individual children attending the LSF’s. These are collaborative sessions incorporating both professionals and parents. Our department continues to inform and support the Autism –pathway from diagnosis to intervention. These working party meetings are held on a monthly basis and the Acting Head SLT represents SLT interests within this forum. The pathway remains a work in progress.


Adult Caseload This service continues to be understaffed and representations were made to the Minister who very kindly met with the team. Following this arrangements were made for locum cover to be made available as from January 2016. This provision will relinquish the 18 hours currently taken from the paediatric special needs caseload and will in effect increase the special needs service. In September 2015, the Clinical Lead within the adult service was selected and successfully audited by HCPC. Stats for the Adult Service during this period are as follows: In patients: October 81 November 72 December 63 Out patients:

October November December

Aphasia 5 6 3

Dysarthria 15 17 11

Dysphagia 22 36 23

Voice 17 14 13

Laryngectomy 7 5 7

Total 66 + ECA

(including 13home visits)

78 + ECA (including 10 home visits)

57+ ECA (including 7 home visits)

Respectfully submitted, Adam Wink PCC UGM


6.9 UGM - Mental Health Services

Introduction The following quarterly report represents the final 3 months of 2015, a hectic but exciting period following our move at the beginning of February. This last 3 months, (Oct-Dec) saw further changes in operational issues as we settled in to a more conducive environment with patients, carers and staff participating in the continued positive changes to the way we deliver our services. The design of all wards and departments encourages and creates an atmosphere that aids and facilitates the process of recovery, providing greater privacy in more relaxed and comfortable surroundings. A team of professionals from different disciplines meeting regularly with patients and carers to review care packages and develop a better therapeutic relation. More open spaces both in terms of the ward environment and the garden area have been enjoyed by all with afternoon teas in the garden for some patients from Dawn and Sunshine to an introduction of ward based groups in other areas. This report represents the work carried out in all departments of the mental health services (in-patient, community and the ARC). It presents the activities from some of these groups, the visits completed in the community by the multi-disciplinary team and the work which we hope to develop over the coming months.

Monthly activity

Community Mental Health Team (CMHT) – Patient contact/staff activity.

0

20

40

60

80

100

120

140

160

180

Dr Segovia Dr Lillywhite Dr Diaz Dr Ruiz Dr Marin Patientsseen inClinics

CommunityVisits

Oct-15 44 92 16 44 22 151 132

Nov-15 39 50 27 70 12 167 141

Dec-15 48 42 22 39 11 169 153

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CMHT - Patient Contact/ Staff Activity table

Psychology therapy offered with the mental health services. Month Number of referrals received October 77 November 61 December 43


Source of referrals Number of referrals received Primary Care 128 Community Mental Health Team 16 Secondary Care 24 Paediatrics 7 Other 6 As in previous months the table above shows that over half of the referrals to Clinical Psychology and Counselling are received from Primary Care. Most of these referrals are for psychological help with problems such as mild to moderate depression, anxiety, bereavement, stress or problems with adjustment to difficult life circumstances. These patients are most appropriately allocated to the Counsellor based in Primary Care who can offer various time limited, solution focused approaches to help people with these types of problems. In-patient data and activities As previously described in earlier reports, despite many community activities, both in terms of consultant contacts, nursing visits to patients home and the psychological intervention provided, some patients will continue to need admission to Ocean views for periods of time. This is seen as part of the journey patients take in their recovery, which is not about eliminating admissions altogether but hopefully reducing the time spent in hospital, for some this may manifest in terms of days or weeks in hospital or in a reduction in the number of times per year they need to be admitted. The mental health teams have strived hard (and will continue to strive) to provide an ever improving service to those who need it, when they need it and how they need it. The charts below capture a number of demographic details, such as; admissions, diagnosis, mental health act status, route of admission for Horizon and Sky ward. Apart from this, also presented are just some of the groups developed with patients which would be in addition to the ARC activities.

In-patient quarterly data – Horizon / Sky

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4

6

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14

16

18

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Oct Nov Dec

Male 13 9 10

Female 6 7 3

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Horizon Ward Admissions Oct-Dec 2015


Other groups / activites held on the Horizon and Sky Arts and crafts x2 sessions every week

Interactive games x2 every week

Bingo x2 every week

X1 patient meeting

Rehabilitation in-patient services - Dawn Ward Data

Dawn ward provides an environment that enables 5 patients to have their own room (single) and 8 patients who share a room (double room). Whereas previously (KGV), the accommodations were the Florence nightingale style wards. The team here has observed tremendous changes in the patient’s behaviour and attitude towards their recovery, a greater willingness and motivation to want to be more involved in ward groups, social integrating outings, cooking groups, art, exercise and relaxation groups. Patients are encouraged to attend the weekly community meeting, held on both Dawn ward and Rockside flats. The data provided in these charts represent the current monthly totals of patients on the ward per month and their current level of dependency, the identified risks (such as


falls, aggression or self-neglect) and the mental health diagnosis of the patients we currently have. 9 male and 3 female (sometimes 9/4)

Elderly care services - Sunshine ward As described above and in previous reports the environment now afforded the patients has changed in-patient experience dramatically, this is true also of the elderly services, patients enjoy a more homely environment, sharing bedrooms with one other person and having the space to sit quietly in a few different areas or watch TV with fellow patients. Visiting continues to take place in the reception, where patients are taken by staff from the ward to enjoy visits from family members in quiet and comfortable surroundings, garden areas, and on ward terraces, when patients could enjoy chatting and engaging with family and friends. The data below provides information on contacts patients have had at any time with the services to mental health. With the current patient acuity on Sunshine ward the level of dependency and risk over the 3 month period presented in this quarterly report has not change, the high dependency noted each month is felt to link with the risk of falls and chocking. As a result patients contact with other services across the GHA is monitored and recorded (as per charts below).

0

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6

8

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14

Oct Nov Dec

4 7 7 7

3 2 3 2

2 2 1 2

1 1 2 1

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Dependency level Oct - Dec 2015


Specialist clinics held and Elder care patients seen by colleagues within ocean

views. Oct 2015

Clinic Number of patients seen General Practitioner 20 Dietician 1 Speech & Language Therapist 1 Physiotherapist 8 Occupational Therapy 120 Catheter Clinic 1

Specialist clinics held and Elderly care patients seen by colleagues within ocean views.

Nov 2015 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 14 Dietician Kate Langdon 1 Speech & Language Therapist

Julie Bradford 1

Physiotherapist Jan Wink 8 Occupational Therapy On-going treatment 116 Catheter Clinic District Nurses 1

Specialist clinics held and Elderly care patients seen by colleagues within ocean views.

Dec 2015 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 22 Dietician Kate Langdon 2 Speech & Language Therapist

Julie Bradford 2

Physiotherapist Jan Wink 8 Occupational Therapy On-going treatment 124 Catheter Clinic District Nurses 2 Monthly sessional attendance by patients to the ARC.

The winter months have bought some changes in the Arc Department. Our Occupational Therapy Technician retired at the end of October 2015 after many years of service. Christmas activities have included arts and crafts, meals out with both inpatients and community patients and a ward party to celebrate the Three Kings. Charity money has enabled us to facilitate these activities. The statistics below show the patient contacts seen in the Arc. This includes both group settings and individual work facilitated either in the hospital setting or in the patients’ home or community. Averages of 19 patient contacts have been seen daily in the Arc. The majority of the patients seen are from Dawn Ward as this is the rehabilitation ward and where we have most input. Averages of 10 patient contacts a day have been seen from Dawn ward.


There has also been a steady increase of referrals and patients seen from Horizon ward (Acute Ward) since our move to the new hospital. There are now two afternoon sessions (Tuesdays and Thursdays) specifically for patients from Horizon ward, to ensure they are able to make use of the Arc to facilitate their needs and recovery. The use of the computers is very well used by these patients. Community patient contacts have increased during Oct/Nov/Dec and have been seen in a variety of settings. These included the relaxation sessions held in Cardiac Rehabilitation and the Drug and Alcohol Unit (Bruce’s Farm), as well as the Coaling Island Lunch Group and individual sessions. The Coaling Island Group now has 5/6 community patients who attend regularly.

Activities completed per month by Arc for ward / community patients Oct Nov Dec Horizon 41 57 21 Dawn 199 237 164 Sunshine 31 51 19 Community 102 111 64 EDUCATIONAL DEVELOPMENTS

Training- as previously mentioned staff CPD plays an important role in the

service delivery, ensuring that staff are fully up to date with changing practices

and in some instances looking at forging these changes themselves – this is

something we hope to tackle in 2016.

Mandatory training, this has continued throughout the period (Oct-Dec), with

staff attending a number of sessions from DCRT, BLS and MH to other sessions

such as dignity and awareness and safeguarding adults. All of these have been

attended by a cross section of the multi-disciplinary team.

Conference attendance – Again a cross section of the multi-disciplinary team

attended a 3 day national congress on managing violence and aggression. This

generated a number of ideas for on-going development, some of which have

already been implemented on their return. It is hoped the next year 2016, we

will be able to not only attend the next congress, but to actively participate by

presenting one of the sessions ourselves.

CLINICAL DEVELOPMENTS

Electronic Patient Records – mental health, phase two, as part of the continued

commitment from Government and the GHA the mental health services have

identified ‘leads’ in all areas. These leads from across the multi-disciplinary

teams have been and will continue to work closely with the existing EPR team in

order to develop the requirements for mental health services.

Rockside flats – Both flats are now in use for the 3 months that this reports

pertains to, patients are developing skills and a better understandings of a

number of social skills and daily activities. This is completed through joint

working of health care professionals both on the ward, in the ARC and the close

liaison with community and social care teams.


Plans for the next 3 months In the New Year and during the first quarter of the year will see even more positive changes to the service. Staff are looking to develop more ward based activities and community outings, the successful appointment of newly qualified staff (both in terms of the RMNS and ENs) will only enrich what is already a very positive service of care to are most vulnerable group within Gibraltar. These are just a few:

Supporting the newly qualified enrolled nurses and staff nurses in their post,

through some aspects of preceptor ship.

The continued involvement of 1st and 2nd year BSc students who are due to

commence student placements with us over the next 6 months.

We have been approached by a number of students from overseas, who are

requesting a short placement in mental health services in Gibraltar, this is seen

as extremely positive and something the teams want to encourage more of.

Supporting 2 nursing assistants who are currently undertaking their 18month

pupil nurse training.

Maintaining staff CPD, mandatory training and any high educational courses staff

identified as part of their yearly appraisals.

Maintaining the work already started in 2015 with respect to the introduction of

EPR, reviewing and implementation improved documentation. A number of

staff will be working in conjunction with the EPR team.

Developing and maintain the work carried out previously on polices pertaining to mental health or GHA as a whole. Respectfully submitted, Chris Chipolina UGM - Mental Health Services


6.10 Information Management and Technology Directorate

Information Technology The backlog of works and outstanding projects which amassed due to the focus on works for the implementation of Phase 1 of the EPR project on 24th June in Primary Care and Accident & Emergency were completed during this quarter. During the 4th quarter the increase in the number of calls to the IT Helpdesk has remained. This is mainly due to a greater number of users actively using the computer systems and a greater need for constant availability of computers and the underlying systems. The remaining works in the hospital Wi-Fi project have been progressing. Quotes for the remedial works were received and a contractor has been engaged based on the quotes submitted. These works will be completed in January 2016. The revised Wi-Fi Policy has been submitted for approval and is due to be presented to the GHA Board on 10th February 2016. It is intended to enable the hospital Wi-Fi, pending approval of the policy, within the 1st quarter of 2016. The planned upgrade of the Radiology Information System (RIS) in 2016 has required the IT department to work closely with the Radiology department to ensure all Radiology workstations were upgraded in readiness for the upgrade. This has now been completed laying the foundation for the upgrade to go ahead in the new year. Activation of the new door access system is now expected during the 1st Quarter of 2015. The contractor and GHA administrative staff continue to work on the door configuration and access lists on the main server and once this is completed works will commence to move over to the new door access controllers installed around the hospital. The department has been closely involved in the introduction of the new Chemotherapy Suite. All IT infrastructural requirements have been installed. This is in preparation for fitting out of the suite with necessary IT and clinical equipment which will require connecting to existing GHA systems and infrastructure. The programmed replacement of the aging hospital CCTV system with a modern IP network based system is on-going. Infrastructure works are completed and camera replacement and configuration will take place during the 1st Quarter of 2016. Work in the Pathology Department continues, assisting in expanding the computerization to a point where the suppliers of the main Laboratory Information System are using the installation as an example of cutting edge implementation of their systems. The dept. is currently assisting with the computerisation of Microbiology. The upgrade of all Microsoft Windows XP workstations to Microsoft Windows 7 continues. The upgrading of hardware and installed applications, when necessary, is conducted hand-in-hand with the migration of individual departments. 95% of all GHA workstations have been migrated with the final 5% programmed for completion in the 1st Quarter of 2016.


Incompatibility of legacy clinical software applications with Windows 7, and the need for the suppliers of these systems to update and test, has delayed the programme and prevented completion by the original target of the end of 2015. Migration from our two aging file servers onto the new GHA file server, with greater storage capacity and much improved performance, is continuing. The remaining server will continue to be migrated into the 1st Quarter of 2016. This goes hand in hand with the migration to Windows 7 on all GHA PCs. Once the Windows 7 migration is complete so will be the file server migration and subsequently the decommissioning of the old server. Due to a number of failures of the Primary Care telephone system throughout 2015, mainly due to overloading of the advanced appointments line first thing in the morning, it was decided to move the incoming feed from Gibtelecom to the PCC. This feed now goes to the Hospital site and maintains a much more stable connection. This seems to have addressed the overloading issue experienced on the advanced appointments line. Over the last months the team has been designing and building a replacement for the GHA internal Intranet. It was widely felt that the existing Intranet, which was designed and built a number of years ago, needed to be modernised with the look and feel of the GHA external website with increased features and functionality. This is almost complete and is due to be implemented in the 1st Quarter of 2016. Additionally, phase 2 of the GHA website is now being worked on. This phase will enable content management of the individual departmental sections to be devolved to the relevant departments. This will empower departments to keep content as up-to-date as possible without having to ask for changes to be made by the GHA webmasters. The Backup/recovery system continues to function well. Data recovery times have been drastically reduced for whenever data or system restoration is required, greatly strengthening the GHA’s disaster recovery strategies and enabling the GHA to recover from any potential disaster in a greatly reduced time frame. However, increases in the amount of data stored by the GHA is putting pressure on the storage capabilities of the backup system. Backup retention times, before being overwritten by a newer backup, are having to be reduced so that the backups can fit on the existing storage systems. This reduces the capability to go back to a specific point in time and increases the risk of not being able to recover lost files or go back to a point before data corruption occurs if the loss or corruption is not discovered within a couple of days. Expansion and upgrading of the backup system is now planned for the next financial year. A request for funding has been submitted in the 2016/17 estimates submission to be able to undertake this essential project.


IMT Helpdesk Our helpdesk continues to be at the core and central to our department. They continue to handle in excess of 600 support calls per month. This continues to demonstrate the GHAs increased use of IT systems and the reliance that our clinicians and administrative staff now have on these systems in order to fulfil their duties. As can be seen in the two tables below the number of calls received has increased due to the installation and troubleshooting of the EMISweb EPR systems which impacts on the helpdesk’s ability to respond in a suitable time frame. It can be seen that the number of support tickets created has risen from under 200 per month to between 350 and 600 per month, up to a 200 per cent increase in support requests. Additionally, a comparison of calls received in Quarters 2, 3 & 4 of 2014 and the same Quarters in 2015 shows that calls have increased by between 100 and 200 calls per month, an increase of 25 to 50 per cent. This continues to negatively impact the helpdesks ability to respond to support requests as swiftly as they have in the past.


IMT Routine Maintenance It was hoped that, as manning levels have been re-established, the department would now be able to embark on the planned routine maintenance schedule for all our desktops and peripherals. The additional burden of support placed on the department since the implementation of the EPR systems has unfortunately not allowed this to be undertaken. Currently much of the current maintenance being undertaken is being done so as part of the Windows migration, as PCs are upgraded to the new operating system. Patient Entertainment System Daily checks continue to be carried out, and a high level of availability and service is provided to patients on this system. Requests to install TVs in the Elderly Care Agencies Cochrane Ward and Calpe Ward are still received but have reduced considerably due to the fact that a large number of the beds now have the installation completed. The movement of many TV channels to HD Video is resulting in the gradual loss of channels as the broadcaster migrates to the better quality format. This is due to the fact that the all of the TV decoders at the patient bedside in GHA Wards cannot receive and decode HD TV signals. Investment in the Patient Entertainment System will be required imminently in order to ensure that a service can continue to be provided. Once the broadcaster has completed moving all channels to HD TV, expected during the course of 2016, then we will no longer be able to provide Patient TV in the GHA wards at the bedside with the current installed equipment. Funding for this has been requested in the estimates submission for 2016/2017. General Regular backups of our main servers and databases continue to ensure the integrity and safety of our data. The growth of data stored on our servers is now beginning to put pressure on our capability to back up all of our data and comply with recognised industry standard intervals. Expansion of the backup systems are required and funding is being requested for this in the next financial year. Our on-call staff are alerted of any equipment issues, alarms, faults via pager, SMS and email avoiding any delay when taking action. Staff training in existing and new systems continues to keep abreast of the fast and changing healthcare technologies. IS Projects Below is an update of the programme of works highlighted in the previous report. Hospital Stores Inventory and Stock Control System Work continues on phase 1 of this project. The intention is to carry out a pilot phase within Stores in the 1st Quarter 2016. Operational requirements in the stores department meant that the pilot phase had to be delayed and was not possible to launch in the 4th Quarter of 2015 as originally intended. Full roll-out of phase 1 of the system will be dependent on the success of the pilot phase and implementing any changes / fixes that arise as a result of this.


Stores & Procurement personnel are currently carrying out a revision of their entire product catalogue for importing into the new system. Phase 1 go live is entirely dependent on completion of this work stream. In Phase 2 of the project an internal website will be created. Staff will be able to use this to submit their stores requests which will be received electronically in the stock control system. Discussions are on-going on required features and scope for this phase which is envisaged to commence mid-2016. Human Resources System The IS team has begun working with the HR department to develop a HR System that pulls together all of the numerous spread sheets, documents, templates and any other form of data repository, be it electronic or paper, and combines everything into one seamless, user friendly system that removes much of the data gathering and repetitive tasks that takes up so much of the HR personnel’s valuable time. Currently at an embryonic stage this project will revolutionise the way the HR department are able to go about their work. By developing it in house we will be able to minimise the need for HR resources to populate the database. by importing existing data, and will also be able to tailor the system to the needs of the department rather than the department having to adapt to the rigid structure of an off the shelf system. As part of this development we will be building a centralised Annual Leave system which will standardise the annual leave process across the organisation. It will also give the HR department immediate access to up-to-date leave records for all GHA staff without having to request from individual directorates or departments. GHA User Account online requesting We have been piloting a replacement for a paper based user account request and IT systems access request form with the Medical HR department. This pilot has proved to extremely successful and it is now planned to implement across the whole organisation during the 1st Quarter of 2016. Cancer registry patient management system – This continues as previous and there might be an opportunity to also populate this register with the introduction of new systems in pathology and radiology. CanReg5 is still being considered as a replacement by the Public Health Department Pathology System ( Vitropath ) – Completed HL7 interfacing for demographics completed, tested and approved, still work in progress since project not yet complete in operational elements. Sponsored Patients – Whilst the Sponsored Patients system is now live, additional requirements and improvements are constantly being identified by the sponsored patients department as they use it in their day to day work. At the request of the department a new feature has been developed and added which allows ‘Guarantee Letters’, for all patients due to attend Xanit on a particular day, to be produced in bulk. Previously users had to go into each Xanit travel one by one and generate the letter. Adding features such as this greatly reduces the manual processing required in routine processes being undertaken by the staff. Enhancements to Screening application –


Re-development of the screening application is on-going, providing additional features and functionality in a rolling programme. It is currently used for Colorectal and AAA screening programmes. As other screening programmes are introduced these will be incorporated as and when needed. Also, additional functionality for recall management and general screening programme is being developed. Labels – There is a growing need to provide utilities to print labels of various denominations for several departments. This development continues with additional departments. Working with EMIS/Ascribe teams – There continues to be a great deal of interaction regarding the outstanding elements of Phase 1 of the EPR project such as the Prescribe/Dispense/Reimburse module. Since the 24th July the level of involvement required from the IS team has reduced but remains constant. Due to the intricacies of some of the existing systems, such as the aforementioned module and also the GHA Health Card printing functionality, the IS team’s involvement is and will continue to be relatively high. This is to enable the EMIS Group’s developers to fully understand what is being replaced and to ensure that they develop and provide the same degree of functionality if not more. There are regular meetings between the EPR programme management teams and the IS team and a good relationship of cooperation and team work has been fostered between all. Medical Registration Board – The MRB are working with an external contractor to create a public facing website for the Board. Development work is being undertaken to export information from the MRB system to the website seamlessly. This is currently a manual process undertaken by the IS technical staff but eventually this will be able to be triggered by the MRB staff by selecting a button in the system. Staff Recertification Database – Work is on-going on a module to record and maintain re-certification and qualifications of GHA staff. This is progressing well and is expected to go live in the 1st Quarter of 2016. Respectfully Submitted, Heath Watson Director of Information Management & Technology


6.11 School of Health Studies

The first cohort of BSc (Hons)/BSc (Adult) Nursing students have completed their programme of study and graduated in November 2015. Nine have secured employment with the GHA, 1 is undertaking midwifery training and 1 teacher training. Three students graduated with a first class honours degree. The second year cohort is progressing well. First year students have commenced their first clinical placements. Evaluations of clinical placement are positive. The third cohort of Pupil Nurses (eighteen month programme) is working towards completion of their QCF level 3 qualification. The QCF Level 2 training programme, in response to local needs, is progressing- this has a work based learning focus assisting staff in developing their knowledge and skills. This programme has been developed to work with the GHA and other government agencies. The Head of School visited KULSGUL to attend the Board of Studies and presented the progression of Gibraltar students. There is parity with student progression in the UK and in Gibraltar. KULSGUL are currently in the process of validating a new curriculum in alignment with NMC standards. The SHS will be required to undergo review of provision in June 2016 and are currently working to ensure this is a success. Two modules, as part of the Continuing Personal and Professional Development (CPPD) portfolio (multidisciplinary), have been run. For the first time a level seven, thirty credit module was offered. A further module identified by senior clinicians, open to the multidisciplinary team is to run early 2016. The Surgical First Assistance module (Edge Hill University) is due for completion early 2016. The SHS are encouraging GHA staff to access CPPD information via Moodle a SHS devised platform for teaching and learning. The two year part time MSc Leadership and Healthcare continues with students now working on their final submission and their chosen dissertations. We continue to work closely with the Medical Director addressing the need for revalidation activity as well as through the UGMs regarding other non-nursing health care professionals (Allied Healthcare Professionals), the Gibraltar Ambulance Service and our Midwifery colleagues. In November 2015 the first cohort of preregistration nursing degree students graduated. At this ceremony 4 RNs had successfully completed and been awarded a Diploma in Healthcare Practice and 12 RNs who have continued with academic studies graduated with a BSc Healthcare Practice. One student is publishing her column for the British Journal of Nursing and one Pupil Nurse has published her piece in the British Journal of Healthcare Assistants. Academic staff in the SHS are publishing work in a variety of health care journals and a range of text books. Finally, up to 3 technical staff from the Estates and Clinical Engineering Department will shortly be undertaking UK accredited training for Medical Gas Authorised Persons. This is a Level 4 BTEC programme and facilitates technicians with obligatory health and safety competency.


6.12 Complaints Handling Scheme

Volume of GHA Complaints/Enquiries 4th Quarter The Complaints Handling Scheme – Health Office has received 57 complaints and 25 enquiries in the last quarter of the year (4th Quarter - 1st October 2015 to 31st December 2015). The busiest month in this quarter was November 2015 with 25 Complaints; this actually was the busiest month of the year since the office opened to the public. The average number of complaints for this last quarter is 19.


Table 1 - Complaints/enquiries received by department

GHA Departments ENT 3 Orthopaedic 10 MI Unit 3 Surgical Unit 8 Gynaecology 2 A & E 7 Facilities 2 PCC 7 Maternity Ward 2 Opthalmology 6 John Mac Ward 2 Radiology 5 Pain Clinic 2 Dental 4 Sponsored Patients 2 Dudley Toomey Ward 4 Others 9 Rainbow Ward 4 TOTAL: 82


Classification of complaints resolved through informal action


Table 2 – Nature of Complaints

Category of Complaints/Enquiries Waiting times/appointments 19 Poor Communication 16 Clinical Issues 14 Bad attitude 4 Loss of records/test results/referrals 4 Cancelled procedure/tests/appointments 4 Loss of property 3 Services 3 Poor Service 3 Phone unanswered 2 Refusal to attend call 2 Records not in clinic 1 Welfare 1 Delay in obtaining results 1 No replies 1 External Agency 1 Policy Issue 1 Resources 1 Poor Coordination 1 TOTAL: 82

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